MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 8194
Change Report (if Any):

Short Name: BIG BR/SIS-KNOX

Long Name 1: BIG BOTHERS BIG SISTERS OF
Long Name 2: KNOX AND MORROW COUNTIES

Address 1: 8868 COLUMBUS ROAD
Address 2: PO BOX 616

City: MOUNT VERNON
Zip Code: 43050
County: KNOX

Contact: JOY HARRIS
Title:
Phone: 7403978733
FAX: 7403978736

Vendor: 8194

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012