C02639;TA113473;TCO3;1;;JEFFREY 23286-771;Southgate Medical Group, Llc;1026 UNION RD;West Seneca;NY;14224;07/09/25
C02639;TA113473;653M120;1;;JEFFREY 23286-771;Southgate Medical Group, Llc;1026 UNION RD;West Seneca;NY;14224;07/09/25
C02639;TA113473;COMP;No
