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Get Part I General Information Requestor's Name And Address Summit Rehabilitaton Centers Co The Morris

DINGS AND DECISION PART I: GENERAL INFORMATION Requestor s Name and Address: MFDR Tracking #: SUMMIT REHABILITATON CENTERS C/O THE MORRIS LAW FIRM 702 S BECKLEY AVE DALLAS TX 75203 M4-07-0239-01 DWC Claim #: Injured Employee: Date of Injury: Respondent Name and Box #: American Home Assurance Co. Rep. Box # 19 Employer Name: Insurance Carrier #: PART II: REQUESTOR S POSITION SUMMARY AND PRINCIPLE DOCUMENTATION Requestor s Position Summary: No EOBs were provided by carrier to under.

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