UPI (Provider ID): 6370
Change Report (if Any):

Short Name: FAM RES-LIMA

Long Name 1: FAMILY RESOURCE CENTERS
Long Name 2:

Address 1: 530 SOUTH MAIN STEET
Address 2:

City: LIMA
Zip Code: 45804
County: ALLE

Contact: ERNIE JOHNSON
Title: CFO
Phone: 4192221168
FAX: 4192227610

Vendor: 6370

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/21/2011

File Produced: 19MAY2012