w York NY 10065 Phone: Rte: 68 Patient Details Specimen Decals Physician Details DOB: 01/2O/1953 Dam coRomed: 09/14/2018 1255 Local Ordering: Vd MERRELL AgeNSINdt %SAMS Date mollified: 09/152018 Referring: Conan: M 55N: Date entered: 09/15/2018 ID: Patient 0: E012053 Ono omens* 09/19/2018 061