UPI (Provider ID): 10237
Change Report (if Any):

Short Name: SPECT-WOODWORKS

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

Address 1: 1810 WEST 25TH STREET
Address 2:

City: CLEVELAND
Zip Code: 44113
County: CUYA

Contact: MICHEL BANKS
Title:
Phone: 2166943767
FAX: 2166233450

Vendor: 10232

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016