C03965;TA112755;TCO3;1;1027316-JB;JEREMY BOOTH-550;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;06/27/25
C03965;TA112755;20014M120;1;1027316-JB;JEREMY BOOTH-550;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;06/27/25
C03965;TA112755;COMP;No
