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Applicant | Gender | Age | DOB | Tobacco Use |
Sample | Male | 53 | 1/1/1967 | No |
Proposal ID: 43506551-0066555127614317 | Proposed Effective Date: 1/1/2020 | Email: Steveshorr@cox.net |
Zip: 90731 | County: Los Angeles | State: CA |
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