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5236 Vogel Rd. Ste A Evansville, IN 47715 Phone: 8124377868 Fax: 8124377228 www.atitherapy.com1102 Triplet St. Ste 2300 Owensboro KY 42303 Phone: 2709267779 Fax: 2709267677PATIENTINFORMATIONANDAUTHORIZATIONName:
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