Payment Summary:
Please pay the full amount on your patient statement. Contact the billing department at kayalbilling@gmail.com or call (770) 426-7177 if you have any questions or need further assistance.
Enter Full Amount: $
Patient Account Number:
           
Credit Card Information:
Name as on Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
[ What is the Card ID?]
   
Phone Number:
Email Address:
     

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