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Eileen C. Comic, M.D. 35 Volley Drive Suite no.102 Bloomfield, CT 06002 Tel (860)2422200 Fax (860)2422212 AUTHORIZATION FOR RELEASE OF RECORDS I, (Please Print Name) hereby authorize Name of Physician:
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Eileen C. Comia MD is a medical doctor who specializes in a specific field of medicine.
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