C03965;TA112783;TCO3;1;1027316-DI;DARRELL INGRAM-547;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;06/27/25
C03965;TA112783;20220M140;1;1027316-DI;DARRELL INGRAM-547;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;06/27/25
C03965;TA112783;COMP;No
