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Directory Results for Department of Neurology 4800 Alberta El Paso, TX 79905 9152155900 9155456705 (fax) PATIENT INATION TTUHSC MRN: Authorization To Release and Disclose Patient Information PATIENT NAME: DATE OF BIRTH: Address: Day Phone: City: State: Zip: to Department of Neurology 8 Medical Park Suite 420

Department of Neurology 4800 Alberta El Paso, TX 79905 9152155900 9155456705 (fax) PATIENT INATION TTUHSC MRN: Authorization To Release and Disclose Patient Information PATIENT NAME: DATE OF BIRTH: Address: Day Phone: City: State: Zip:
Department of Neurology 8 Medical Park Suite 420