UPI (Provider ID): 6748
Change Report (if Any):

Short Name: FRESH ATTITUDE

Long Name 1: FRESH ATTITUDE INC
Long Name 2:

Address 1: 525 HAMILTON STREET
Address 2: SUITE 102

City: TOLEDO
Zip Code: 43602
County: LUCA

Contact: LAMAR NORWOOD
Title: EX DR
Phone: 4192444081
FAX: 4192444084

Vendor: 6748

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012