C01630;TA111851;525XXW105;1;;Jesse Porter;Kevin Powers, Dpm;1791 W Third Street;Bloomington;IN;47404;06/12/25
C01630;TA111851;TDIMXW105;3;;Jesse Porter;Kevin Powers, Dpm;1791 W Third Street;Bloomington;IN;47404;06/12/25
C01630;TA111851;COMP;No
