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8823 San Jose Blvd., Ste. 301, Jacksonville, FL 32217 PH: (904) 6388164 FAX: (904) 3794736 www.desaihealth.comAUTHORIZATION TO RELEASE OR OBTAIN HEALTH CARE INFORMATION Patient Name:Date of Birth:Address:Phone:I
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8823 San Jose Blvd refers to a specific address in Jacksonville, Florida, which may be associated with businesses or residences.
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