UPI (Provider ID): 10405
Change Report (if Any):

Short Name: SPECT-BRUSH

Long Name 1: SPECTRUM OF SUPPORTIVE SERVICE
Long Name 2: WILLOW ARMS

Address 1: 27201 BRUSH AVENUE
Address 2:

City: EUCLID
Zip Code: 44143
County: CUYA

Contact: STEPHEN MORSE
Title:
Phone: 2169392065
FAX: 2169392075

Vendor: 10232

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016