UPI (Provider ID): 3461
Change Report (if Any):

Short Name: LUCY IDOL

Long Name 1: LUCY IDOL CENTER FOR THE
Long Name 2: HANDICAPPED

Address 1: 435 NICHOLSON AVENUE
Address 2: PO BOX 162

City: VERMILION
Zip Code: 44089
County: LORA

Contact: CAROL PECK
Title:
Phone: 4409676724
FAX: 4409674495

Vendor: 3461

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/13/2011

File Produced: 19MAY2012