UPI (Provider ID): 6949
Change Report (if Any):

Short Name: YORK AVE TREAT

Long Name 1: YORK AVENUE CHURCH OF GOD
Long Name 2: TREATMENT CENTER

Address 1: 1228 WEST MARKET STREET
Address 2:

City: WARREN
Zip Code: 44485
County: TRUM

Contact: JOHNNY GRAHAM
Title:
Phone: 3303924199
FAX: 3303924904

Vendor: 6948

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012