extracted from his canadian pharmacy account.
Customer No: 611527
First Name: Charles
Last Name: McKinley
Email: mckinley212@yahoo.com
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