UPI (Provider ID): 10357
Change Report (if Any):

Short Name: AP SMHS CSN

Long Name 1: AP SUPPORT MENTAL HEALTH
Long Name 2: SERVICES CSN

Address 1: 9259 LIBERTY SCHOOL ROAD
Address 2: SUITE B

City: CAMBRIDGE
Zip Code: 437258987
County: GUER

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

Vendor: 3275

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/10/2012

File Produced: 14JUL2016