UPI (Provider ID): 10313
Change Report (if Any):

Short Name: EMERALD DEVELOP

Long Name 1: EMERALD DEVELOPMENT AND
Long Name 2: ECONOMIC NETWORK INC

Address 1: 7812 MADISON AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44102
County: CUYA

Contact: KATHY KAZOL
Title: EX DR
Phone: 2169619690
FAX: 2166514066

Vendor: 10313

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 06/28/2012

File Produced: 14JUL2016