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Full Name: KatyaWom1<br>Email: Fudgetuptade@gmail.com<br>Phone: 83595373319<br>Select Patient: Returning Patient<br>Select COVID-19 Evaluation Request: Yes<br>Please provide your: Insurance Carrier / Reason for Visit: How about we try that new wine bar everyone's been raving about for a cozy evening together?  -   https://rb.gy/5nfvy9?Wom<br><br>---<br><br>Date: March 23, 2024<br>Time: 9:31 am<br>Page URL: <br>User Agent: Mozilla/5.0 (Windows NT 6.3) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/103.0.0.0 Safari/537.36<br>Remote IP: 172.111.131.114<br>