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1912 Hayes Avenue Sandusky, Ohio 44870 Phone: 4195022800 Fax: 4195022821Authorization to Release Medical Records PATIENT INFORMATION: NAME: DOB: MAN: ADDRESS: SS# PATIENT INFORMATION IS NEEDED FOR:
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Phone number 419-502-2800 is a contact number for a specific organization or individual.
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Individuals or entities who are requested or required to provide their contact information.
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