UPI (Provider ID): 13101
Change Report (if Any):

Short Name: MAGNOLIA

Long Name 1: MAGNOLIA CLUBHOUSE
Long Name 2:

Address 1: 11101 MAGNOLIA DRIVE
Address 2:

City: CLEVELAND
Zip Code: 44106
County: CUYA

Contact: LORI DANGELO
Title: EXDIR
Phone: 2167213030
FAX: 2167210105

Vendor: 13099

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/22/2011

File Produced: 14JUL2016