UPI (Provider ID): 10648
Change Report (if Any):

Short Name: PSYCHOBIOLOGY

Long Name 1: PSYCHOBIOLOGY CLINIC OF
Long Name 2: GREATER CLEVELAND INC

Address 1: 12200 FAIRHILL ROAD
Address 2:

City: CLEVELAND
Zip Code: 44120
County: CUYA

Contact: MELVIN LAWRENCE
Title: ADM
Phone: 2162317050
FAX: 2162317054

Vendor: 10648

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016