C03965;TA102168;TCO3;1;1027316-SP;STACEY PELLEGRINO-893;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;12/18/24
C03965;TA102168;90002M095;1;1027316-SP;STACEY PELLEGRINO-893;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;12/18/24
