Name | ||
Attn | ||
Address | ||
Address | ||
City, State Zip | , | |
Phone | ||
CMS ID | ||
Payer Type | {html_options name="freeb_type" options=$insurancecompany->freeb_type_array selected=$insurancecompany->get_freeb_type()} | |
Default X12 Partner | {html_options name="x12_default_partner_id" options=$x12_partners selected=$insurancecompany->get_x12_default_partner_id()} | |