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Get Sample Request Form 2019

One Number Product Description Product Number 72384-752-01 72384-753-01 Professional Designation MD DO PA State NP Zip Office Fax Number Office Email Address Please Check Item(s) Requested: () 100MG 1CT. 1 in 1 Blister Pkg () 200MG 1CT. 1 in 1 Blister Pkg. 6 Units 6 Units Quantity and frequency of orders may be limited due to availability and/or at the discretion of Metuchen Pharmaceuticals Anticipated delivery time is 5 -10 business days. Instructio.

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