Edit an Existing Claim Administrator

 Employer Name
 Location Name
 Department Name
 Hidden Record ?
 Record Marked for Delete ?

 Claim Administrator Name
 Claim Administrator Address
 Claim Administrator City
 Claim Administrator County
 Claim Administrator State
 Claim Administrator Postal Code  - 
 Claim Administrator Phone  )   - 
 Claim Administrator FEIN  - 
 Claim Administrator StateID