C01630;TA105166;20019XW095;1;;Mark Bault;Kevin Powers, Dpm;1791 W Third Street;Bloomington;IN;47404;02/26/25
C01630;TA105166;TDIMXW095;3;;Mark Bault;Kevin Powers, Dpm;1791 W Third Street;Bloomington;IN;47404;02/26/25
