UPI (Provider ID): 12790
Change Report (if Any):

Short Name: CORNEL ABRX COL

Long Name 1: CORNELL ABRAXAS GROUP
Long Name 2: ABRAXAS COUNSELING CENTER

Address 1: 899 EAST BROAD STREET
Address 2:

City: COLUMBUS
Zip Code: 43215
County: FRAN

Contact: INEZ FERRANTE
Title: DIR
Phone: 6144588647
FAX: 4197470067

Vendor: 6967

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/07/2012

File Produced: 14JUL2016