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Please complete the form below. You may also call us at (866) MY-LI-DOC (866-695-4362) on weekdays, 8 a.m. to 6 p.m. Please call 9-1-1 if this is a medical emergency.

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Call (866) MY-LI-DOC (866-695-4362), Monday-Friday, 8 a.m. to 6 p.m., to speak to a physician referral specialist.