UPI (Provider ID): 10235
Change Report (if Any):

Short Name: SPECT-14411 TRI

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

Address 1: STUART HOUSE APARTMENTS
Address 2: 14411 TRISKET ROAD

City: CLEVELAND
Zip Code: 44111
County: CUYA

Contact: MICHEL BANKS
Title:
Phone: 2162817872
FAX: 2162917916

Vendor: 10232

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016