rg-pat~1riversidegastro.com/forms/rg-patientinfo.pdf1304 somerville road decatur, alabama 35601...

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Page 1: RG-PAT~1riversidegastro.com/Forms/RG-PatientInfo.pdf1304 Somerville Road Decatur, Alabama 35601 (256) 260-2333 Zip: Zip Code Zip Code Employed Separated Retired Divorced Middle City:
Page 2: RG-PAT~1riversidegastro.com/Forms/RG-PatientInfo.pdf1304 Somerville Road Decatur, Alabama 35601 (256) 260-2333 Zip: Zip Code Zip Code Employed Separated Retired Divorced Middle City: