UPI (Provider ID): 6694
Change Report (if Any):

Short Name: D V SHELT-STAR

Long Name 1: DOMESTIC VIOLENCE PROJECT
Long Name 2:

Address 1: PO BOX 9459
Address 2:

City: CANTON
Zip Code: 447119432
County: STAR

Contact: MELISSA PEARCE
Title: PGDIR
Phone: 3304452000
FAX: 3304452007

Vendor: 6694

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/06/2011

File Produced: 19MAY2012