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ePassport™

*AI********D**

AI********D*

For Clinic Use:

Clinic Information:

Concentra Medical Center - Airport Phoenix

**** * *** ****** *** N

STE 150

PHOENIX,AZ 85034

ph #:602-***-****

DON'T FORGET!

- Take ePassport and Photo ID

- All other documents provided

- Call clinic to confirm...