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Get Authorization To Disclose Health Information Form - Anchor Clinic

890 S. PALAFOX STREET, SUITE 300 ? PENSACOLA, FL 32502 ? (850) 433-1656 VOICE ? (850) 433-1996 FAX 543 HARBOR BLVD, SUITE 101 ? DESTIN, FL 32541 ? (850) 650-0555 VOICE ? (850) 650-1955 FAX Authorization.

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