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Text File  |  1995-09-11  |  161b  |  20 lines
  1. NAME:
  2. CONTACT:
  3. ADDR1:
  4. ADDR2:
  5. ADDR3:
  6. CITY:
  7. STATE:
  8. ZIP:
  9.  PHONE:
  10.  FAX:
  11. EXT:
  12. FAX:
  13. EXT:
  14. TITLE:
  15. ASSISTANT:
  16. SALUTATION:
  17. RESULTS:
  18. STATUS:
  19. REFERRED:
  20.