Licensee Name:PROVANTAGE MAIL SERVICES INC.
License Type:NON RESIDENT PHARMACY
License Number:115
License Status:CANCELLED Definition
Expiration Date:January 01, 2002
Issue Date:January 27, 1994
Address:408 LOMBARDI AVENUE
City:GREEN BAY
State:WI
Zip:54307
County:OUT OF STATE
Actions:No
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