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2 8 0 8 O L D PO S T R O A D H A R IS B U R G, PA 1 7 1 1 0 P H O N E (7 1 7) 9 0 1 6 8 0 0 F A X (7 1 7) 9 0 1 6 6 9 9 Date: Patient name: The above named patient was seen in our office today at.
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