C04415;TA113421;TCO3;1;42348;RUSSELL MCALLISTER-574;Horton's Orthotic Lab-Jonesboro;2760 Browns Lane Suite A ;Jonesboro;AR;72401;07/09/25
C04415;TA113421;20015W100;1;42348;RUSSELL MCALLISTER-574;Horton's Orthotic Lab-Jonesboro;2760 Browns Lane Suite A ;Jonesboro;AR;72401;07/09/25
C04415;TA113421;COMP;No
