UPI (Provider ID): 11031
Change Report (if Any):

Short Name: HB LORAIN MH

Long Name 1: HB LORAIN SCHOOL BASED MH TEAM
Long Name 2:

Address 1: CO APPLEWOOD 618 LEONA STREET
Address 2:

City: ELYRIA
Zip Code: 44035
County: LORA

Contact: KATHLEEN OBERLIN
Title:
Phone: 4403249734
FAX: 4403249516

Vendor: 3275

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016