Picture of TOPS™ UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms

TOPS™ UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms

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TOPS™ UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms
Manufacturer: TOPS™
SKU: SSIN1-8246514-WS
Manufacturer part number: 59870R
GTIN: 025932598708
Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Form Size: 8 1/2 x 11; Forms Per Page: 1; Form Quantity: 2500; Layout: One Form per Sheet.
$276.25
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Availability: 5 in stock
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