UPI (Provider ID): 10427
Change Report (if Any):

Short Name: SPECT-21860 RIV

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

Address 1: 21860 RIVER OAKS DRIVE UNIT 9
Address 2:

City: ROCKY RIVER
Zip Code: 44116
County: CUYA

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

Vendor: 10232

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016