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Get Nevada X Ray Registration Form

S REG NO. NAME OF FACILITY TELEPHONE NUMBER FAX NUMBER MAILING STREET ADDRESS CITY STATE ZIP CODE ADDRESS WHERE MACHINE WILL BE USED (IF DIFFERENT) CITY STATE ZIP CODE DEPARTMENT OR ROOM WHERE MACHINE WILL BE USED TITLE (e.g., RSO) NAME OF PERSON RESPONSIBLE FOR RADIATION E-MAIL ADDRESS HUMAN MEDICAL X-RAY Radiographic stationary Radiographic mobile and portable Fluoroscopic Combination radiographic and fluoroscopic C-arm biopsy / stereotactic DEXA bone density.

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