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      <InCareOfNm>% Renel Phanord</InCareOfNm>
      <BusinessNameControlTxt>BREA</BusinessNameControlTxt>
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        <AddressLine1Txt>3596 Tamiami Trail Ste 101</AddressLine1Txt>
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      <StatesWhereCopyOfReturnIsFldCd>FL</StatesWhereCopyOfReturnIsFldCd>
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          <CityNm>Port Charlotte</CityNm>
          <StateAbbreviationCd>FL</StateAbbreviationCd>
          <ZIPCd>33952</ZIPCd>
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      <ForeignOfficeInd>false</ForeignOfficeInd>
      <DonorAdvisedFndsInd>false</DonorAdvisedFndsInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <TanningServicesProvidedInd>false</TanningServicesProvidedInd>
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      <SchoolOperatingInd>false</SchoolOperatingInd>
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