UPI (Provider ID): 12179
Change Report (if Any):

Short Name: SOUTH OH BH HTH

Long Name 1: SOUTHERN OHIO BEHAVIORAL
Long Name 2: HEALTH

Address 1: 2113 SOUTH 7TH STREET
Address 2:

City: IRONTON
Zip Code: 45638
County: LAWR

Contact: W MICHAEL DOWDY
Title: EXDIR
Phone: 7405330055
FAX: 7405323832

Vendor: 12179

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/04/2012

File Produced: 14JUL2016