• 1. Enter Patient Information
  • »
  • 2. Enter Payment Information
  • »
  • 3. Review and Authorize
  • »
  • 4. Payment Confirmation
Please enter login information exactly as it appears on your Statement - including all spaces and punctuation.
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  •  Full Patient Name:
     
     Account Number:
     
     State:
     
     
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If you have any questions, please call Customer Service at 1-866-889-9968.