| Name | Description | Type | Additional information |
|---|---|---|---|
| Address1 | string |
None. |
|
| Address2 | string |
None. |
|
| City | string |
None. |
|
| Fax | string |
None. |
|
| InsuranceName | string |
None. |
|
| Phone | string |
None. |
|
| State | string |
None. |
|
| Zip | string |
None. |
|
| InsuranceId | integer |
None. |