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Fred Leroy Health and Wellness Center Ponca Hills Health and Wellness Center 2602 J Street Omaha NE 68107 1800 Syracuse Ave Norfolk NE 68701 Authorization for RELEASE OF INFORMATION Signature of the patient is required of all patients 18 years of age or older. Unless otherwise revoked this authorization will expire on the following date event or condition. If I fail to specify an expiration date event or condition this authorization will expire in six months. 524. I understand that any...
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{Although there is no specific information available regarding the address 2602 J Street in Omaha, it could be a residential or commercial property located in that area.}
{The individual or entity who owns or is responsible for the property located at 2602 J Street in Omaha may be required to file any relevant documents or forms related to that property.}
{To properly fill out any forms or documents related to the property at 2602 J Street in Omaha, one should carefully review the instructions provided, gather all necessary information, and ensure accurate completion of the required fields.}
{The purpose of any documents or forms related to the property at 2602 J Street in Omaha could vary, but it likely pertains to ownership, tax assessment, or other legal obligations related to the property.}
{The specific information required to be reported on any documents related to the property at 2602 J Street in Omaha would depend on the nature of the form, but could include details such as ownership information, property value, or tax status.}
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