UPI (Provider ID): 13536
Change Report (if Any):

Short Name: MAY DUGAN CNTER

Long Name 1: NEAR WEST SIDE MULTI SERVICES
Long Name 2: DBA MAY DUGAN CENTER

Address 1: 4115 BRIDGE AVENUE
Address 2:

City: CLEVELAND
Zip Code: 441133304
County: CUYA

Contact: RICK KEMM
Title: EXDIR
Phone: 2166315800
FAX: 2166314595

Vendor: 60217

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 07/24/2014

File Produced: 14JUL2016