Company Name:{{ $data->company_name }}

Group Npi:{{ $data->group_npi }}

Order Phyisician Name:{{ $data->order_phyisician_name }}

Physician Npi:{{ $data->physician_npi }}

Purchasing Contact Name:{{ $data->purchasing_contact_name }}

Phone Number:{{ $data->phone_number }}

Email:{{ $data->email }}

Shipping Address:{{ $data->shipping_address }}

Line 2:{{ $data->line_2 }}

City:{{ $data->city }}

State:{{ $data->state }}

Zip:{{ $data->zip }}

Agrees To Terms:{{ $data->agrees_to_terms }}