C03965;TA112037;TCO3;1;1027316-DH;JOHN BEREZNAK-246;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;06/16/25
C03965;TA112037;28003M110;1;1027316-DH;JOHN BEREZNAK-246;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;06/16/25
C03965;TA112037;COMP;No
