MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10395
Change Report (if Any):

Short Name: BRIDGEWAY-CANTE

Long Name 1: BRIDGEWAY INC
Long Name 2:

Address 1: 6617 SOUTH CANTERBURY DRIVE
Address 2:

City: PARMA
Zip Code: 44130
County: CUYA

Contact: GENISE HERBERT
Title:
Phone: 2167213030
FAX: 2167213096

Vendor: 10509

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016