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Specify hospitals at which the physicians hold staff or courtesy privileges Hospital Name JCAHO or ADA APPROVED Type of Privileges VIII. OPERATIONS Fully describe your operations B1. Main Location Street Address Owned Leased B2. Sq. ft. Rockbridge Underwriting an RLI Company 3700 Buffalo Speedway Suite 300 Houston TX 77098 713 874-8800 Main PROFESSIONAL LIABILITY INSURANCE APPLICATION FOR MULTI-PRACTICE CLINIC OR LARGE GROUP PRACTICE INSTRUCTIONS Please complete all sections and sign. If a...

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