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OfficeInformation: 12002BanderaRoad,Suite111 Helots,Texas78023 P:(210×6959002 F:(210×6959044 Patient Authorization for Release of Protected Health Information Patient Name: Date of Birth: / / Address:
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p2106959002 is a specific tax form used for reporting certain financial information to the tax authorities.
Individuals or entities that meet certain criteria set by the tax authorities are required to file p2106959002.
p2106959002 can be filled out by providing accurate and complete financial information as per the instructions provided by the tax authorities.
The purpose of p2106959002 is to report specific financial information to the tax authorities for compliance and tax assessment purposes.
p2106959002 requires reporting of income, expenses, deductions, and other financial information as specified by the tax authorities.
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