Barta Medika Clinic.docx

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BARTA MEDIKA CLINIC Jl. Pulau Nias No 5 Tabanan , Jl. Gunung Andakasa No.7XX Denpasar, Bali No tlp: (081558004444) Email: [email protected]

Yang bertanda tangan dibawah ini, pimpinan Barta Medika Clinic Nama

: dr. I Ketut Sumiarta M.Kes

Tempat/tanggal lahir

: Tabanan, 30 Agustus 1961

Alamat

: Br. Dinas Tengah Kerambitan Tabanan

Menyatakan tidak keberatan terhadap Nama

:

Tempat/tanggal lahir

:

Alamat

:

Untuk praktek fisiotherapy di Barta Medika Clinic. Demikian pernyataan persetujuan ini saya buat dengan penuh kesadaran dan tanpa paksaan agar dapat dipergunakan sebagaimana mestinya

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