extracted from his canadian pharmacy account.


Customer No:	611527
First Name:	Charles
Last Name:	McKinley
Email:[email protected]Daytime Phone:	972-746-9124
Evening Phone:	972-891-2603
Address:	225 Shadybrook Dr
Address 2:	
City:	Wylie
Country:	US
State/Province:	TX
Zip/Postal Code:	75098


Denotes Required Fields
* First Name:
Charles
* Last Name:
McKinley
* Gender:
Male
* Date of Birth:
09
Month
/
11
Date
 /
1968
Year
* Height:
6
Feet
'
5
Inches
"
* Weight:
265
lbs
* Do you have any known drug allergies?
Yes
Drug Allergies
Allergies:  Penicillian
Reaction:  unknown