UPI (Provider ID): 10482
Change Report (if Any):

Short Name: BEACON-CLEVE

Long Name 1: BEACON AGENCY INC
Long Name 2:

Address 1: 1836 EUCLID AVENUE SUITE 500
Address 2:

City: CLEVELAND
Zip Code: 44115
County: CUYA

Contact: LARA BURKETT
Title: ADMN
Phone: 2162740300
FAX: 2162740301

Vendor: 10483

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016