Service Location Information Copy Service Location Address

Tax ID: {{serviceLocationInfo?.taxIdNumber || '\u2013\u2013\u2013'}}
Vendor: {{serviceLocationInfo?.name || '\u2013\u2013\u2013'}}
Address 1: {{serviceLocationInfo?.addressLineOne || '\u2013\u2013\u2013'}}
Address 2: {{serviceLocationInfo?.addressLineTwo || '\u2013\u2013\u2013'}}
City: {{serviceLocationInfo?.city || '\u2013\u2013\u2013'}}
State: {{serviceLocationInfo?.state || '\u2013\u2013\u2013'}}
ZIP Code: {{serviceLocationInfo?.postalCode || '\u2013\u2013\u2013'}}
Country: {{serviceLocationInfo?.country || '\u2013\u2013\u2013'}}
NPI: {{serviceLocationInfo?.npi || '\u2013\u2013\u2013'}}

Billing Provider Information

Tax ID: {{billingProviderInfo?.taxIdNumber || '\u2013\u2013\u2013'}}
Vendor: {{billingProviderInfo?.name || '\u2013\u2013\u2013'}}
Address 1: {{billingProviderInfo?.addressLineOne || '\u2013\u2013\u2013'}}
Address 2: {{billingProviderInfo?.addressLineTwo || '\u2013\u2013\u2013'}}
City: {{billingProviderInfo?.city || '\u2013\u2013\u2013'}}
State: {{billingProviderInfo?.state || '\u2013\u2013\u2013'}}
ZIP Code: {{billingProviderInfo?.postalCode || '\u2013\u2013\u2013'}}
Country: {{billingProviderInfo?.country || '\u2013\u2013\u2013'}}
NPI: {{billingProviderInfo?.npi || '\u2013\u2013\u2013'}}
Taxonomy Code: {{billingProviderInfo?.billingVendorTaxonomyCode || '\u2013\u2013\u2013'}}