UPI (Provider ID): 10233
Change Report (if Any):

Short Name: SPECT -W 99TH

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

Address 1: 3199 WEST 99TH STREET
Address 2:

City: CLEVELAND
Zip Code: 44102
County: CUYA

Contact: MICHEL BANKS
Title:
Phone: 2163770140
FAX: 2163770151

Vendor: 10232

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016