UPI (Provider ID): 10226
Change Report (if Any):

Short Name: MH TAYLOR-INTAK

Long Name 1: MURTIS H TAYLOR
Long Name 2: INTAKE ACT

Address 1: 3101 EUCLID AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44115
County: CUYA

Contact: PHYLLIS DUKES
Title: CPO
Phone: 2164317514
FAX: 2164317536

Vendor: 3042

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016