UPI (Provider ID): 10232
Change Report (if Any):

Short Name: SPECT-2900 DETR

Long Name 1: SPECTRUM OF SUPPORTIVE SERVICE
Long Name 2:

Address 1: 2900 DETROIT AVENUE FL 3
Address 2:

City: CLEVELAND
Zip Code: 44113
County: CUYA

Contact: STEPHEN MORSE
Title: CEO
Phone: 2169392065
FAX: 2169392075

Vendor: 10232

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 02/27/2012

File Produced: 14JUL2016