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Does this employee require injury treatment? Does this employee require injury treatment? Yes No
WC Payor - Please provide your WC info if you would prefer that we bill your insurance. If your company would like to be billed directly, please input BILL DIRECT. - Please provide your WC info if you would prefer that we bill your insurance. If your company would like to be billed directly, please input BILL DIRECT.
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AFC Urgent Care West Chester - Mason
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