UPI (Provider ID): 6857
Change Report (if Any):

Short Name: SIGNATURE-WILLO

Long Name 1: SIGNATURE HEALTH INC
Long Name 2:

Address 1: 38879 MENTOR AVENUE SUITE C
Address 2:

City: WILLOUGHBY
Zip Code: 44094
County: LAKE

Contact: JONATHAN LEE
Title: EX DR
Phone: 4409539999
FAX: 4409183839

Vendor: 6857

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 04/18/2012

File Produced: 14JUL2016