UPI (Provider ID): 10228
Change Report (if Any):

Short Name: MH TAYLOR-BUCKE

Long Name 1: MURTIS H TAYLOR
Long Name 2: BUCKEYE

Address 1: 11410 BUCKEYE ROAD
Address 2:

City: CLEVELAND
Zip Code: 44104
County: CUYA

Contact: TITUS MUNYASYA
Title:
Phone: 2167210444
FAX: 2167210988

Vendor: 3042

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016