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Sex: male female
Have you smoked in the last 12 months? yes no
Additional Comments:
Grant Park Festival Unit 4-1170 Taylor Ave. phone: (204) 953-4600 fax: (204) 953-4611 grantpark@coughlin.com
Crossroads Station Unit 6-1570 Regent Ave. W phone: (204) 953-4620 fax: (204) 953-4622 crossroads@coughlin.com
