UPI (Provider ID): 12773
Change Report (if Any):

Short Name: BEECH BROK-WEIZ

Long Name 1: BEECH BROOK
Long Name 2: WEIZER BLDG

Address 1: 11801 BUCKEYE ROAD
Address 2:

City: CLEVELAND
Zip Code: 44120
County: CUYA

Contact: DAVID DITULLIO
Title: SUPV
Phone: 2168312255
FAX: 2168310436

Vendor: 10205

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/23/2012

File Produced: 14JUL2016