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Practice Name: (please print)Practice Address: (please print)Street City State Zippier Phone Main Fax Main Email Main Contact: Preferred Method of Contact: pH FX Malpractice Administrator: Phone Billing
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Practice address refers to the physical location where a business or professional practice operates from.
All businesses or professionals with a physical location are required to file their practice address.
You can fill out practice address by providing the full address including street number, name, city, state, and zip code.
The purpose of practice address is to provide a location where customers or clients can visit and to establish the physical presence of the business.
The information reported on practice address typically includes the full street address, city, state, and zip code.
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