UPI (Provider ID): 3676
Change Report (if Any):

Short Name: SOUTH COMMUNITY

Long Name 1: SOUTH COMMUNITY INC
Long Name 2:

Address 1: 3095 KETTERING BLVD
Address 2:

City: DAYTON
Zip Code: 45439
County: MONT

Contact: JEFFREY LAKES
Title: CFO
Phone: 9372938300
FAX: 9375341352

Vendor: 3676

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/28/2011

File Produced: 19MAY2012