UPI (Provider ID): 1084
Change Report (if Any):

Short Name: FREE CLINIC

Long Name 1: FREE CLINIC OF GREATER
Long Name 2: CLEVELAND

Address 1: 12201 EUCLID AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44106
County: CUYA

Contact: DANNY WILLIAMS
Title: EX DR
Phone: 2167214010
FAX: 2167073528

Vendor: 1084

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/20/2011

File Produced: 14JUL2016