EXAMPLE - RADIOLOGIST W10000 tate an asalt nsane 1 enes ... · Frankfort NY 13340 13502 G2111119...
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W910000 State and Casualty Insurance 17 Avengers Street Walker, Diana 07 12 1982 21 Acme Valley Road 17 Calvary Drive Frankfort NY 13340 5555555 13502 2222222 G2111119 Walker^^^Diana Y4 Y0078792156 State and Casualty Insurance Signature on File 05 27 2018 431 0B 110300 DN Leon Mandrake 5999777777 REFX5003333-4^^^G2RAD^^^PWK06EAC00985621^^^NTEADD20200302 0 M79672 OB 003333 01 15 20 01 15 20 11 73630 LT A 86 12 1 6000888888 160001111 0078 86 12 333 3333333 Bangalla Imaging Associates Bangalla Imaging Associates 65 Wanderlust Circle 65 Wanderlust Circle Anthony Lothar, MD Syracuse NY 13208 Syracuse NY 13208 01/16/2020 4888999999 4888999999 White Plains, NY 10604 123-45-6788 Xanadu Enterprises Utica NY 222 555 EXAMPLE - RADIOLOGIST X
Transcript of EXAMPLE - RADIOLOGIST W10000 tate an asalt nsane 1 enes ... · Frankfort NY 13340 13502 G2111119...
W910000State and Casualty Insurance17 Avengers Street
Walker, Diana 07 12 1982
21 Acme Valley Road 17 Calvary Drive
Frankfort NY
13340 5555555 13502 2222222
G2111119
Walker^^^Diana Y4 Y0078792156
State and Casualty Insurance
Signature on File
05 27 2018 4310B 110300
DN Leon Mandrake 5999777777
REFX5003333-4^^^G2RAD^^^PWK06EAC00985621^^^NTEADD20200302
0M79672
OB 003333
01 15 20 01 15 20 11 73630 LT A 86 12 1 6000888888
160001111 0078 86 12333 3333333
Bangalla Imaging Associates Bangalla Imaging Associates65 Wanderlust Circle 65 Wanderlust Circle
Anthony Lothar, MD Syracuse NY 13208 Syracuse NY 1320801/16/2020 4888999999 4888999999
White Plains, NY 10604
123-45-6788
Xanadu Enterprises
Utica NY
222555
EXAMPLE - RADIOLOGIST
X