UPI (Provider ID): 10460
Change Report (if Any):

Short Name: FAR WEST-AMHERS

Long Name 1: FAR WEST CENTER
Long Name 2:

Address 1: 554 LEAVITT ROAD SUITE 550
Address 2:

City: AMHERST
Zip Code: 44001
County: LORA

Contact: HELEN DYLAG
Title: PRES
Phone: 4409884900
FAX: 4409884910

Vendor: 2505

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 03/01/2012

File Produced: 14JUL2016