UPI (Provider ID): 10356
Change Report (if Any):

Short Name: AP SUPR LIV CSN

Long Name 1: AP SUPERVISED LIVING CSN
Long Name 2:

Address 1: 2510 JOHN GLENN HWY
Address 2:

City: CAMBRIDGE
Zip Code: 437258987
County: GUER

Contact: DEBRA KOSKO
Title:
Phone: 7404320428
FAX: 7404320250

Vendor: 3275

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/10/2012

File Produced: 14JUL2016