Rank: 
Private
Service number: 
12654
Unit: 
11th Field Ambulance
Location: 
55 General Hospital, Boulogue-sur-Mer, France
Enquirer: 
Packet number: 
2893
Date range: 
1917
SLSA record number: 
SRG 76/1/2893

From other sources

National Archives of Australia: 

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