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A completed field indicates a change. Business Phone Number Type of Facility Business or Practice e.g. dental medical veterinary etc. Mailing Address street number and name No Longer a Mammography FOR RADIOLOGIC HEALTH BRANCH USE ONLY RH 2261C 11/14 Page 1 of 5 Manufacturer Model Room Name or Number Registered Machine Changes provide new or corrected information only Number of X-ray Tubes Waveguides or Electron Guns Type Code Additional Informati....

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