UPI (Provider ID): 10252
Change Report (if Any):

Short Name: BELLEFAIRE-MARK

Long Name 1: BELLEFAIRE JEWISH
Long Name 2: CHILDRENS BUREAU

Address 1: 1411 MARKET AVENUE NORTH
Address 2:

City: CANTON
Zip Code: 44714
County: STAR

Contact: BRIAN KELLY
Title: CONT
Phone: 3304563209
FAX: .

Vendor: 2447

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016