C03965;TA112216;TCO3;1;1027316-SP;STACEY PELLEGRINO;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;06/18/25
C03965;TA112216;90002M075;1;1027316-SP;STACEY PELLEGRINO;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;06/18/25
C03965;TA112216;COMP;No
