UPI (Provider ID): 6343
Change Report (if Any):

Short Name: TEEN INSTITUTE

Long Name 1: GEAUGA COUNTY BOARD OF EDUCAT
Long Name 2: TEEN INSTITUTE FOR PREVENTION

Address 1: 470 CENTER STREET SUITE 2
Address 2:

City: CHARDON
Zip Code: 440241068
County: GEAU

Contact: WALLY WALDBAUER
Title:
Phone: 4402852222
FAX: 4402867106

Vendor: 6343

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012