C02639;TA113472;TCO1;1;;ELOISE 23530-772;Southgate Medical Group, Llc;1026 UNION RD;West Seneca;NY;14224;07/09/25
C02639;TA113472;80061M070;1;;ELOISE 23530-772;Southgate Medical Group, Llc;1026 UNION RD;West Seneca;NY;14224;07/09/25
C02639;TA113472;COMP;No
