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0938-0391 STATEMENT OF DEFICIENCIES X1 PROVIDER/SUPPLIER/CLIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER 15C0001143 X2 MULTIPLE CONSTRUCTION A. BUILDING X3 DATE SURVEY COMPLETED 10/05/2011 B. WING STREET ADDRESS CITY STATE ZIP CODE NAME OF PROVIDER OR SUPPLIER 1115 N RONALD REAGAN PKWY STE 347 AVON IN46123 INDIANA ENDOSCOPY CENTERS X4 ID SUMMARY STATEMENT OF DEFICIENCIES ID PREFIX EACH DEFICIENCY MUST BE PERCEDED BY FULL TAG REGULATORY OR LSC IDENTIFYING INFORMATION PROVIDER S PLAN OF...

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1115 N Ronald Reagan is a tax form used for reporting income and deductions for individuals.

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