UPI (Provider ID): 2505
Change Report (if Any):

Short Name: FAR WEST CENTER

Long Name 1: FAR WEST CENTER
Long Name 2:

Address 1: 29133 HEALTH CAMPUS DRIVE
Address 2:

City: WESTLAKE
Zip Code: 441455256
County: CUYA

Contact: LYNN STENGER
Title: INFO
Phone: 4408356212
FAX: 4408356231

Vendor: 2505

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/05/2012

File Produced: 14JUL2016