MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 7033
Change Report (if Any):

Short Name: MH TAYLOR

Long Name 1: MURTIS H TAYLOR MULTI SERVICE
Long Name 2:

Address 1: 13402 KINSMAN ROAD
Address 2:

City: CLEVELAND
Zip Code: 44120
County: CUYA

Contact: TITUS MUNYASYA
Title:
Phone: 2162834400
FAX: 2162831295

Vendor: 3042

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016