MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 7136
Change Report (if Any):

Short Name: PROJECT LIMA

Long Name 1: PROJECT IMPACT LIMA INC
Long Name 2:

Address 1: 309 WEST HIGH STREET
Address 2:

City: LIMA
Zip Code: 45801
County: ALLE

Contact: MICHAEL HENDERSON
Title: DIR
Phone: 4192294406
FAX: 4192294407

Vendor: 7136

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012