UPI (Provider ID): 10643
Change Report (if Any):

Short Name: SA/MI ACT TEAM

Long Name 1: SA MI ACT SYTHESIS TEAM
Long Name 2:

Address 1: 11420 LORAIN AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44111
County: CUYA

Contact: RALPH LEE
Title:
Phone: 2168899640
FAX: 2168899625

Vendor: 10509

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016