UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11" 500 Per Pack
| Country | USA |
| Brand | The Filing Supplies Shop |
| Manufacturer | TFP Data Systems |
| Binding | Office Product |
| ItemPartNumber | UB04LC1 |
| Color | White |
| Size | in |
| UnitCount | 1000 |
| ReleaseDate | 0000-00-00 |