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Nomor Kartu : 0003341119656

Nama : FITRI APRIANI UMI LAEL


Alamat : JL. RASAMALA 4 NO 47 BAS 005/007 CIREBON
GIRANG, TALUN, KAB. CIREBON
Tanggal : 04-04-1990
NIK : 3209084404900002
Faskes : SUSUKAN LEBAK

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