UPI (Provider ID): 10239
Change Report (if Any):

Short Name: SPECT -DENISON

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

Address 1: 9830 DENISON AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44102
County: CUYA

Contact: MICHEL BANKS
Title:
Phone: 2169618826
FAX: 2169618826

Vendor: 10232

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016