Primary Care Provider| Primary Care Provider | [A. Name] | ||
|---|---|---|---|
| Specialty Type | [field-value] | ||
| Start Date | [Date] | End Date | [Date] |
| State Wide Coverage | [True] | ||
| Status Code | [Active] |
View Primary Care Provider
| Primary Care Provider | [A. Name] | ||
|---|---|---|---|
| Specialty Type | [field-value] | ||
| Start Date | [Date] | End Date | [Date] |
| State Wide Coverage | [True] | ||
| Status Code | [Active] |