UPI (Provider ID): 10207
Change Report (if Any):

Short Name: BEECH BROK-54TH

Long Name 1: BEECH BROOK
Long Name 2:

Address 1: 1810 WEST 54TH STREET
Address 2:

City: CLEVELAND
Zip Code: 44102
County: CUYA

Contact: MARK GROVER
Title: DIR
Phone: 2168312255
FAX: .

Vendor: 10205

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016