C03965;TA112764;TCO3;1;1027316-IF;ISABEL FONTANEZ-546;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;06/27/25
C03965;TA112764;80025M080;1;1027316-IF;ISABEL FONTANEZ-546;WILKES-BARRE GWV;1155 EAST MTN. BLVD, ENTRANCE "A" PODIATRY;WILKES BARRE;PA;18711;06/27/25
C03965;TA112764;COMP;No
