C04415;TA112655;TCO3;1;;KELLY SIMMONS-450;Horton's Orthotic Lab-Jonesboro;2760 Browns Lane Suite A ;Jonesboro;AR;72401;06/26/25
C04415;TA112655;80014W090;1;;KELLY SIMMONS-450;Horton's Orthotic Lab-Jonesboro;2760 Browns Lane Suite A ;Jonesboro;AR;72401;06/26/25
C04415;TA112655;COMP;No
