DOB: 10/27/1931
Address: Sonata West (Independent Living) – 420 Roper Rd, Winter Garden, FL 34787
Medical Plan: Medical Health: Member ID #1A73-HC3-TC87
Medical Plan Supplement: BCBS Roche; Member ID# HLR3HZN56752000 Group# 75036-0021Plan Code: 280-780
Medical Proxy and POA: Thomas A. Kovatch; 201-739-2169; tkovatch@aol.com
