UPI (Provider ID): 5004
Change Report (if Any):

Short Name: UMADAOP-LIMA

Long Name 1: LIMA URBAN MINORITY ALCOHOL
Long Name 2: DRUG ABUSE OUTREACH PROGRAM

Address 1: 608 WEST HIGH STREET
Address 2:

City: LIMA
Zip Code: 45801
County: ALLE

Contact: MYRTLE BOYKIN-LIGHTO
Title: EX DR
Phone: 4192224474
FAX: 4192227044

Vendor: 5004

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/04/2012

File Produced: 19MAY2012