Punya Info Klinik Alternatif ?
<font size=2>Kirimkan info Seputar Klinik Alternatif Indonesia,  ulasan, Alamat dan sebagainya bisa disampaikan melalui form dibawah ini.</font>
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Alamat Lengkap Tempat Klinik *
Penjelasan Details tentang Klinik *
Email Klinik (jika Ada...)
Website Klinik (jika ada...)
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