H;C01268;C01268;;20250714;TA113705;;;;;Foot & Ankle Physicians & Surgeons - Toledo;3055 W Sylvania Ave.;;Toledo;OH;43613;;;;003
D;410XXW120;;PR;1;Ramie Mourad;
D;TDIMXW120;;PR;1;Ramie Mourad;
D;COMP;;PR;No;;