C03655;TA112405;647M110;1;06232025GR;JAMES CLARK;PA Artificial Limb & Brace;224 West 26th Street;Erie;PA;16508;07/02/25
C03655;TA112405;TDIMM110;3;06232025GR;JAMES CLARK;PA Artificial Limb & Brace;224 West 26th Street;Erie;PA;16508;07/02/25
C03655;TA112405;COMP;No
