UPI (Provider ID): 10094
Change Report (if Any):

Short Name: NB TRUM CTT CSN

Long Name 1: NB TRUMBULL COMMUNITY
Long Name 2: TREATMENT TEAM CSN

Address 1: 418 MAIN AVENUE SW SUITE 102
Address 2:

City: WARREN
Zip Code: 44481
County: TRUM

Contact: KIM CONNOR
Title:
Phone: 3303946017
FAX: 3303947091

Vendor: 3275

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016