EFTA01195208.pdf

Pay By Mail ---- Pleas e detach and return bottom scut Include account number on check an MOUNT SINAI 6\ DERMATOPATHOLOGY Account Patien i PO BOX 5024 I NEW YORK, NY 10087-5024 Statement Date Amount Due Due Date Return Service Requested 2/26/15 $ 195.00 Upon Receipt For your protection: Do not include the credit card informatio Make CHECK payable and remit to: 11191iiiiiinimilliilillinriniuntiliiilliiiIIIIIIIII MOUNT SINAI DERMATOPATHOLOGY PO Box 5024 NEW YORK, NY 10087-5024 EFTA01195208