Health Center Registration

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Category^*

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Always Open

Stroke Medicine Availability

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Address Line 1^*

Address Line 2^*

City^*

State^*

Country^*

Pincode^*

Latitude^*

Longitude^*

Landmark

Primary Phone Number^*

Secondary Phone Number

Emergency Contact Number^*

Contact Person Name^*

Contact Person Email

Contact Person Mobile^*

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File	File Type	Uploaded	Primary	Action

	First Name ^*	Last Name^*	Qualification ^*	Registarion Number^*	Mobile^*	Action

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