Online Physician Enrollment

Instructions to Enroll 

1. Fill out the Application/Bank Draft Form below and email, fax or mail to the numbers or address below.

2. For Questions or Assistance Please use our Contact page.

APPLICATION/BANK DRAFT FORM


Alliance For Small Business

PO Box 101807

Fort Worth, TX 76185

Phone: (866) 261-4262

or (817) 732-6155

Fax: (817) 377-9591

Email

paul@ineedhealthinsurance.com

 

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