UPI (Provider ID): 8215
Change Report (if Any):

Short Name: COLEMAN - PORTG

Long Name 1: COLEMAN PROFESSIONAL SERVICES
Long Name 2:

Address 1: 5982 RHODES ROAD
Address 2:

City: KENT
Zip Code: 44240
County: PORT

Contact: MARY DAGUE
Title:
Phone: 8006034327
FAX: 3306783677

Vendor: 8215

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 02/16/2012

File Produced: 14JUL2016