	 Received provider data record form via email from Susdey. Documents completed and sent by fax to 817-633-5729. Attachments uploaded and placed on the server.Below is the reference email. -------------- Susdey Sud  Attachments Mon, Aug 31, 3:17 PM (2 days ago) to me  Hello,  As requested, please see the attachment.  Susdey Sud Director, Network Operations Office Phone: (800) 975-3322 Office Fax: (817) 633-5729