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MEDICAL RELEASE OF RECORDS AUTHORIZATION FORM

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Please choose which office you will be going to

Office Address 1

3440 Lomita Blvd, Suite 447,
Torrance CA 90505-4829
P: 424 250 9186
F:323 345 6468

Office Address 2

2785 Pacific Avenue, Suite B. Long Beach, CA 90806
P: (562) 317 5531
F:(844) 825-0061

© Coastal Perinatal Center 2014, All Rights Reserved, 3440 Lomita Blvd, #447. Torrance, CA, 90505. Phone (424)250-9186 / 2785 Pacific Avenue, Suite B. Long Beach, CA 90806 phone:(562) 317 5531

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