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State of Arizona Board of Homeopathic and Integrated Medicine Examiners 1400 West Washington, Ste 230, Phoenix, AZ 85007 Telephone 602-542-8154 Fax 602-542-3093 email: FORM III MEDICAL ASSISTANT APPLICATION (Note: PREVIOUSLY LICENSED PRACTITIONERS please utilize this form) Submit one form and fee of $200.00 for each Medical Assistant within two...
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