C04323;TA106139;BCO3;1;#12345;Test Patient;XY Podiatry Test;1925 North Prospect Avenue Apt F;Milwaukee;WI;53202;03/12/25
C04323;TA106139;40031M100;1;#12345;Test Patient;XY Podiatry Test;1925 North Prospect Avenue Apt F;Milwaukee;WI;53202;03/12/25
