MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10330
Change Report (if Any):

Short Name: EXCEL DEVELOP

Long Name 1: EXCEL DEVELOPMENT CO INC
Long Name 2:

Address 1: 801B WEST 8TH STREET
Address 2: SUITE 524

City: CINCINNATI
Zip Code: 45203
County: HAMI

Contact: DEBORAH AVERY
Title:
Phone: 5136327149
FAX: 5136327171

Vendor: 10330

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 04/11/2012

File Produced: 14JUL2016