Michael Taymor, MD
I HEREBY AUTHORIZE YOU TO FURNISH ANY AND ALL INFORMATION YOU HAVE REGARDING THE ABOVE PATIENT’S MEDICAL HISTORY AND PHYSICAL CONDITION, INCLUDING IMMUNIZATIONS TO:
MICHAEL TAYMOR, MD
145 N. CALIFORNIA AVE.
PALO ALTO, CA 94301
TEL: (650) 321-7722
FAX: (650) 326-7775
THANK YOU FOR YOUR COOPERATION.
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