DINAS KESEHATAN
UPT PUSKESMAS PARUNGPONTENG
PUSTU DESA GIRIKENCANA
Jl.Lengkongjaya RT.016 RW.002 Desa Girikencana 46185
No.HP : 081323117102
Nama : .....................................................................................................................................
Umur : ..................................................................................................................................
Pekerjaan : ......................................................................................................................................
Alamat : ......................................................................................................................................
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Untuk : ......................................................................................................................................
Demikian surat keterangan ini saya buat dan dapat dipergunakan seperlunya.
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Nama : .....................................................................................................................................
Umur : ..................................................................................................................................
Pekerjaan : ......................................................................................................................................
Alamat : ......................................................................................................................................
......................................................................................................................................
Untuk : ......................................................................................................................................
Demikian surat keterangan ini saya buat dan dapat dipergunakan seperlunya.
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