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| Type | [field-value] | Validity Period Units | [field-value] |
|---|---|---|---|
| Value | [field-value] | Provider Category | [field-value] |
| Validity Period | [field-value] | Provider Type | [field-value] |
| Type | [field-value] | Validity Period Units | [field-value] |
|---|---|---|---|
| Value | [field-value] | Provider Category | [field-value] |
| Validity Period | [field-value] | Provider Type | [field-value] |