UPI (Provider ID): 11234
Change Report (if Any):

Short Name: AP LIBERTY CSN

Long Name 1: AP LIBERTY MANOR CSN
Long Name 2:

Address 1: 9259 LIBERTY SCHOOL ROAD
Address 2:

City: CAMBRIDGE
Zip Code: 43725
County: GUER

Contact: DEBRA KOSKO
Title: DIR
Phone: 7404320455
FAX: .

Vendor: 3275

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/10/2012

File Produced: 14JUL2016