C01630;TA110969;652M090;1;;Donald Harris;Kevin Powers, Dpm;1791 W Third Street;Bloomington;IN;47404;05/29/25
C01630;TA110969;TDIMM090;3;;Donald Harris;Kevin Powers, Dpm;1791 W Third Street;Bloomington;IN;47404;05/29/25
C01630;TA110969;COMP;No
