BWC SPOONER MAI

X 07-828596

ZATVARNICKY, MICHAEL 01 04 60 X ZATVARNICKY, MICHAEL

2220 WOODLAND TRACE X 2220 WOODLAND TRACE

AUSTINTOWN OH YOUNGSTOWN OH

44515 330 5024640 44515 330 5024640

ZATVARNICKY,MICHAEL 5/8/2007

JRI701W09472 X 01 04 60 X

X BWC SPOONER MAI

ANTHEM MDCR ADV X

SIGNATURE ON FILE 05/23/2024 SIGNATURE ON FILE

9
296.23

04 15 24 11 90837 A $175 00 1 1386158509

34-1879439 X ID4207163 X 0 00 0 00
330 7839690
CENTER FOR BEHAVIORAL HEAL CENTER FOR BEHAVIORAL HEAL
725 BOARDMAN CANFIELD RD 725 BOARDMAN CANFIELD RD
WILLIAM COMBS, LPCC BOARDMAN, OH 445124381 BOARDMAN, OH 44512-4381
05/23/2024 1881792778 1881792778