UPI (Provider ID): 10272
Change Report (if Any):

Short Name: EPILEPSY - CUYA

Long Name 1: EPILEPSY ASSOCIATION
Long Name 2:

Address 1: 2831 PROSPECT AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44115
County: CUYA

Contact: GEORGIANNE BOERNER
Title: DIR
Phone: 2165791330
FAX: 2165791336

Vendor: 10272

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 02/28/2012

File Produced: 14JUL2016