UPI (Provider ID): 6704
Change Report (if Any):

Short Name: CN FAM/CHL LAKE

Long Name 1: CENTER FOR FAMILIES CHILDREN
Long Name 2: HISPANIC COUNSELING

Address 1: 14701 DETROIT AVENUE SUITE 620
Address 2:

City: LAKEWOOD
Zip Code: 44107
County: CUYA

Contact: JOHN HECKMAN
Title: FISC
Phone: 2162218654
FAX: 2162212294

Vendor: 8227

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016