UPI (Provider ID): 10243
Change Report (if Any):

Short Name: SPECT -WESTGATE

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

Address 1: 21585 CENTER RIDGE ROAD
Address 2:

City: ROCKY RIVER
Zip Code: 44116
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