UPI (Provider ID): 10205
Change Report (if Any):

Short Name: BEECH BROK-LAND

Long Name 1: BEECH BROOK
Long Name 2:

Address 1: 3737 LANDER ROAD
Address 2:

City: CLEVELAND
Zip Code: 44124
County: CUYA

Contact: JENIFER MORABITO
Title: IS
Phone: 2168312255
FAX: 2168310436

Vendor: 10205

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 05/25/2012

File Produced: 14JUL2016