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Register Office Details Below (supplies provided by vendor partner)

(copy of physician license required if ordering injectables)

Offices Save 17-23% On Average

INJECTABLES

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Register Office

This is the primary doctor of your practice. This is information that we will use when referring to your account.

MD, DPM, Other

This is a person that has been authorized to make or change orders for your practice.

Upload Physician License
Max File Size 15MB
UPLOAD COPY OF PHYSICIAN LICENSE ABOVE.  THIS IS REQUIRED PER THE FDA (WHEN BUYING INJECTABLES)

330-459-8000

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