New or Updated Practice Details - Canberra Imaging Group

New or Updated Practice Details:

Practice Name

Street Address

Apt, suite, etc.

Country

City

State

Zip code

Postal Address (if different to street address)

Apt, suite, etc.

Country

City

State

Zip code

Contact Phone Number

Contact Fax Number

Practice Email

Practice Website

Practice Fetch ID

You may use this for Capital Pathology too.

Practice Manager Name

Practice Manager Email

Practice Manager Number