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West ford Proton Fitchburg 133 Littleton Road, Suite 101 West fords, MA 01886 Tel: (978× 5770437 Fax: (978×6929904 AUTHORIZATION TO USE AND DISCLOSE PROTECTED HEALTH INFORMATION Patient Name: DOB:

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Westford Groton Fitchburg is a joint economic development initiative between the towns of Westford, Groton, and Fitchburg to promote regional economic growth and development.

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