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efta-efta01195208DOJ Data Set 9OtherPay By Mail -- Please detach and return bottom scut
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DOJ Data Set 9
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efta-efta01195208
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Pay By Mail -- Please detach and return bottom scut
-- Include account number on check an
MOUNT SINAI
6\ DERMATOPATHOLOGY
i
PO BOX 5024
I
NEW YORK, NY 10087-5024
Return Service Requested
Account
Statement Date
Amount Due
Patien
Due Date
2/26/15
$ 195.00
Upon Receipt
For your protection: Do not include the credit card informatio
Make CHECK payable and remit to:
11191iiiiiinimilliilillinriniuntiliiilliiiIIIIIIIII
MOUNT SINAI DERMATOPATHOLOGY
PO Box 5024
NEW YORK, NY 10087-5024
EFTA01195208
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