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Elm croft Of Quail Springs 14300 North Portland Oklahoma City, OK 73134 ×P) (405× 7556469 ×F) (405×7556474 AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION Except as otherwise permitted

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2. Start by writing the house or building number "14300" in the designated space or line. Make sure to write it clearly and legibly.
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14300 North Portland is a form that needs to be filed with certain information.

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