UPI (Provider ID): 10697
Change Report (if Any):

Short Name: COLEMAN - STARK

Long Name 1: COLEMAN PROFESSIONAL SERVICES
Long Name 2:

Address 1: 400 TUSCARAWAS STREET W
Address 2: SUITE 200

City: CANTON
Zip Code: 44702
County: STAR

Contact: SANDRA MYERS
Title:
Phone: 3304382400
FAX: 3304383003

Vendor: 8215

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 02/04/2012

File Produced: 14JUL2016