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AhmadSaeedAta, M.D. GreenvillePhone:(903)4508122Fax:(903)4542785 Francophone:(214)6180808Fax:(469)7311060 NAME: DOB: / / AGE: SS#: ADDRESS: CITY/STATE: ZIP: PRIMARYPHONE: SECONDARY: WORK: OKAYTOLEAVEDETAILEDMESSAGE?YES

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