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FOR OF USELL1
2003STATE OF ILLINOIS
DEPARTMENT OF PUBLIC AID
FINANCIAL AND STATISTICAL REPORT FOR
LONGER CARE FACILITIES
(FISCAL YEAR 2003)I.DPH Facility ID Number:
Facility Name:0010058II.CERTIFICATION
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What is fax 217-379-3000?
Fax 217-379-3000 is a form used for reporting certain information to a specific organization.
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