<div id="<%= dom_id card_provider %>" class="w-full sm:w-auto my-5 space-y-5">
  <div>
    <strong class="block font-medium mb-1">Provider code:</strong>
    <%= card_provider.provider_code %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 1:</strong>
    <%= card_provider.provider_line_1 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 2:</strong>
    <%= card_provider.provider_line_2 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 3:</strong>
    <%= card_provider.provider_line_3 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 4:</strong>
    <%= card_provider.provider_line_4 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 5:</strong>
    <%= card_provider.provider_line_5 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Mail to:</strong>
    <%= card_provider.mail_to %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Mail to 2:</strong>
    <%= card_provider.mail_to_2 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Contact line 1:</strong>
    <%= card_provider.contact_line_1 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Contact line 2:</strong>
    <%= card_provider.contact_line_2 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Contact line 3:</strong>
    <%= card_provider.contact_line_3 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Group number:</strong>
    <%= card_provider.group_number %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 1:</strong>
    <%= card_provider.claim_to_1 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 2:</strong>
    <%= card_provider.claim_to_2 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 3:</strong>
    <%= card_provider.claim_to_3 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 4:</strong>
    <%= card_provider.claim_to_4 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 5:</strong>
    <%= card_provider.claim_to_5 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 6:</strong>
    <%= card_provider.claim_to_6 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 7:</strong>
    <%= card_provider.claim_to_7 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 8:</strong>
    <%= card_provider.claim_to_8 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 9:</strong>
    <%= card_provider.claim_to_9 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 10:</strong>
    <%= card_provider.claim_to_10 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 11:</strong>
    <%= card_provider.claim_to_11 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 6:</strong>
    <%= card_provider.provider_line_6 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 7:</strong>
    <%= card_provider.provider_line_7 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 8:</strong>
    <%= card_provider.provider_line_8 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 9:</strong>
    <%= card_provider.provider_line_9 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 10:</strong>
    <%= card_provider.provider_line_10 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 11:</strong>
    <%= card_provider.provider_line_11 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Rx group:</strong>
    <%= card_provider.rx_group_id %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Rx contact:</strong>
    <%= card_provider.rx_contact %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider lookup 1:</strong>
    <%= card_provider.provider_lookup_1 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider lookup 2:</strong>
    <%= card_provider.provider_lookup_2 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Precert 1:</strong>
    <%= card_provider.precert_1 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Precert 2:</strong>
    <%= card_provider.precert_2 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Precert 3:</strong>
    <%= card_provider.precert_3 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Precert 4:</strong>
    <%= card_provider.precert_4 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Precert 5:</strong>
    <%= card_provider.precert_5 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Precert 6:</strong>
    <%= card_provider.precert_6 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Provider line 12:</strong>
    <%= card_provider.provider_line_12 %>
  </div>
  <div>
    <strong class="block font-medium mb-1">Claim to 12:</strong>
    <%= card_provider.claim_to_12 %>
  </div>
</div>
