Phone: Fax: Internet: 70-2808 tient Order Form
Patient Order Form 800-748-7001 Medical Conditions Check box if you DO NOT want childproof caps America’s Trusted Online Pharmacy Male Female Personal Information Cat Dog Other Mailing Address: 7107 Industrial Rd, Florence, KY 41042 For medication(s) that you wish to order, please enter the quantity and the listed price (as ................
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