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Provider Enrollment
Confidentiality StatementThe terms and conditions of this agreement are absolutely confidential between the parties and shall not be disclosed to anyone else, except as shall be necessary to effectuate its terms. Any disclosure in violation of this section shall be deemed a material breach of this agreement.
In order to use this website, you must first complete the Provider Enrollment Form below. During registration a user is required to give certain information (such as name and email address). This information is used to enroll you as a provider and to contact you about the services on our site in which you have expressed interest.
While we use encryption to protect sensitive information transmitted online, we also protect your information offline. Only authorized personnel who need the information to perform a specific duty (e.g. provider or customer service) are granted access to personal identifiable information. The computers/servers on which we store personal identifiable information are kept in a secure environment.