MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 12873
Change Report (if Any):

Short Name: TARRY HOUSE

Long Name 1: TARRY HOUSE INC
Long Name 2:

Address 1: 564 DIAGONAL ROAD
Address 2:

City: AKRON
Zip Code: 44320
County: SUMM

Contact: MICHAEL BULLOCK
Title: EXDIR
Phone: 3302536689
FAX: 3302536680

Vendor: 12873

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/10/2011

File Produced: 14JUL2016