UPI (Provider ID): 6967
Change Report (if Any):

Short Name: CORNELL ABRAXAS

Long Name 1: CORNELL ABRAXAS GROUP
Long Name 2:

Address 1: 2775 STATE ROUTE 39
Address 2:

City: SHELBY
Zip Code: 44875
County: RICH

Contact: INEZ FERRANTE
Title: FNDIR
Phone: 4197473322
FAX: 4197473504

Vendor: 6967

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/07/2012

File Produced: 14JUL2016