UPI (Provider ID): 6375
Change Report (if Any):

Short Name: N AMERICAN INDN

Long Name 1: NORTH AMERICAN INDIAN
Long Name 2: CULTURAL CENTER

Address 1: 111 West Avenue
Address 2:

City: Tallmadge
Zip Code: 44278
County: SUMM

Contact: LANNA SAMANIEGO
Title:
Phone: 3307241280
FAX: 3307249298

Vendor: 6375

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 06/28/2012

File Produced: 14JUL2016