TLUS
MI
AHCA
FMSP
FFFS
TRAININGHCOPERATIONALB
123456
490681111
011111111
KIM
CRAWFORD
123123
JANET
DICKERSON
09/01/1930
1301 E JACKSON ST
PHOENIX
AZ
42743738
850342313
G0154
A92.5
NON
NON
09/05/2019 17:07:00
09/05/2019 17:15:00
33.444791
-112.05501
09/05/2019 17:07:00
09/05/2019 17:15:00
125
300
DENV
1301 E Jackson St
Phoenix
AZ
850342313
UNBL
2
1
1190
MRTH SRVC 1190 Invalid ReasonCode1