MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 6331
Change Report (if Any):

Short Name: E CLEVE TALK 2

Long Name 1: EAST CLEVELAND STRAIGHT TALK
Long Name 2:

Address 1: 12921 EUCLID AVENUE
Address 2:

City: EAST CLEVELAND
Zip Code: 44112
County: CUYA

Contact: MARK ROBINSON
Title: DIR
Phone: 2162293784
FAX: 2162292746

Vendor: 10335

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016