UPI (Provider ID): 10428
Change Report (if Any):

Short Name: SPECT-2519 DETR

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

Address 1: 2519 DETROIT AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44113
County: CUYA

Contact: SUSAN GOODRICH
Title: FINDR
Phone: 2169392065
FAX: 2169392075

Vendor: 10232

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016