UPI (Provider ID): 6816
Change Report (if Any):

Short Name: ADELANTE

Long Name 1: ADELANTE
Long Name 2:

Address 1: 520 BROADWAY STREET
Address 2:

City: TOLEDO
Zip Code: 43602
County: LUCA

Contact: KAREN WEBER
Title: DIR
Phone: 4192448440
FAX: 4192441660

Vendor: 6816

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012