UPI (Provider ID): 8310
Change Report (if Any):

Short Name: COUNSELING-TUSC

Long Name 1: PERSONAL FAMILY COUNSELING
Long Name 2: SERVICES OF TUSC VALLEY INC

Address 1: 1433 FIFTH STREET NW
Address 2:

City: NEW PHILADELPHIA
Zip Code: 44663
County: TUSC

Contact: GREGG MARTINI
Title: FIS
Phone: 3303438171
FAX: 3303438439

Vendor: 8310

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 02/15/2012

File Produced: 19MAY2012