UPI (Provider ID): 9425
Change Report (if Any):

Short Name: FAM GUID-LAWR

Long Name 1: IRONTON LAWERENCE COUNTY
Long Name 2: FAMILY GUIDANCE CENTER

Address 1: 1518 S 3RD STREET
Address 2:

City: IRONTON
Zip Code: 45638
County: LAWR

Contact: ANNE ERWIN
Title: EX DR
Phone: 7405327855
FAX: 7405320557

Vendor: 9425

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/20/2011

File Produced: 19MAY2012