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MRN# Patient_Last Patient_First PATIENT_DOB_YYYY-MM-DD Patient_Address1 Patient_Address2 Patient_Phone Patient_Phone Ordering_Location_Name Ordering_Location_Add1 Ordering_Location_Add2 Ordering_Location_City2 Ordering_Location_Phone
MLD-12-000366 GALVIS CAROLINA 2001/1/1 0001 PALISADES AVE 2010005500 MEDICAL LABORATORY DIAGNOSTICS 85 HORSE HILL ROAD CEDAR KNOLLS 9737312900