UPI (Provider ID): 11016
Change Report (if Any):

Short Name: BEECH BROK-MERC

Long Name 1: BEECH BROOK
Long Name 2:

Address 1: 23355 MERCANTILE ROAD
Address 2:

City: BEECHWOOD
Zip Code: 44122
County: CUYA

Contact: WALTER LEITCH
Title:
Phone: 2168312255
FAX: 2168310436

Vendor: 10205

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016