EFTA00272649

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MYTOT1E 0101ROF REQUIRO SCIENTIA LLC PALM BEACH. FL 33480 Rims rrnt4 RIND Shield I Thin Thnntand TINA Hundred Eleven and 70/100 Blue Cross Blue Shield PO Box 538660 Atlanta. GA 303S3-8660 FIFTH Tiiimo BANK 639171.670 7037 CMCCMCW 07/17/15 $ ''2.211179 **Weft OrlipfOr*•**... lr,00 70 37i1 i:06 709 L 719t: 74 338 123 230 1 EFTA00272649

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