Patient Notebook

Legacy EMS, Inc.

PO Box 527

Melville, LA 71353

Phone: (337) 623 - 0056

Fax: (337) 623 - 4789

Website: www://legacyemsinc.com

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1. LEGACY EMS, INC.

First Name

M.I.

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Located on top right corner

Date of Service

Email Address

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P (337) 623 - 0056

F (337) 623 - 4789

W www://legacyemsinc.com

PO Box 527

Melville, LA 71353