TEXAS REGIONAL ASTHMA AND ALLERGY CENTER, L.L.P.
If left blank, expires 1 year from signing or until revoked in writing.
I authorized you (TRAAC) to request confidential health information about me from the person(s) or entity listed below:
Please forward the requested information to:
Texas Regional Asthma & Allergy Center
900 E. Southlake Blvd. Suite 300
Southlake, TX 76092
817-421-0770 (Phone) 817-421-4759 (Fax)
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