MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 7160
Change Report (if Any):

Short Name: SELF CENTER

Long Name 1: ALTERNATIVES AGENCY INC
Long Name 2: SELF CENTER

Address 1: 1804 EAST 55TH STREET
Address 2:

City: CLEVELAND
Zip Code: 44104
County: CUYA

Contact: WILL VANHORN
Title:
Phone: 2163617359
FAX: .

Vendor: 7160

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016