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A Study of BMS-512148 (Dapagliflozin) in Patients With Type 2 Diabetes With Inadequately Controlled Hypertension on an ACEI or ARB and an Additional Antihypertensive Medication

Phase 3
Completed
Conditions
Type 2 Diabetes
Interventions
Registration Number
NCT01195662
Lead Sponsor
AstraZeneca
Brief Summary

The purpose of this study is to learn if BMS-512148 (Dapagliflozin), after 12 weeks, can improve (decrease) blood pressure in patients with type 2 diabetes with uncontrolled hypertension who are on an Angiotensin-converting enzyme inhibitor (ACEI) or an Angiotensin Receptor Blocker (ARB).The safety of this treatment will also be studied

Detailed Description

Not available

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
2245
Inclusion Criteria
  • Written informed consent
  • Males and females, 18 to 89 years old, with type 2 diabetes with inadequate glycemic control HbA1c between 7-10.5% and uncontrolled hypertension Systolic Blood Pressure (SBP) 140-165 and Diastolic Blood Pressure (DBP) 85-105
  • Subjects must have a mean 24 hr blood pressure ≥ 130/80 determined by Ambulatory Blood Pressure Monitoring (ABPM) within 1 week prior to Day 1 visit
  • Stable dose of oral antidiabetic agent (OAD) for at least 6 weeks [12 wks for Thiazolidinedione (TZD)] or a stable daily dose of insulin, as a monotherapy or in combination with another OAD, for 8 weeks, and a stable dose of ACEI or ARB and 1 additional antihypertensive medication for at least 4 weeks
  • C-peptide ≥ 0.8 ng/mL
  • Body Mass Index ≤ 45.0 kg/m2
  • Serum creatinine < 1.50 mg/dL for men or < 1.40 mg/dL for women
Exclusion Criteria
  • Aspartate aminotransferase (AST) and /or Alanine aminotransferase (ALT) > 3.0*upper limit of normal (ULN)
  • Serum total bilirubin ≥ 1.5*ULN
  • Creatinine kinase > 3*ULN
  • Symptoms of severely uncontrolled diabetes
  • History of malignant or accelerated hypertension
  • Currently unstable or serious cardiovascular, renal, hepatic, hematological, oncological, endocrine, psychiatric, or rheumatic diseases

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Dapagliflozin 10 mgDapagliflozinDapagliflozin 10 mg tablets
Placebo matching DapagliflozinPlacebo matching DapagliflozinPlacebo tablets matching dapagliflozin tablets
Primary Outcome Measures
NameTimeMethod
Adjusted Mean Change From Baseline in Seated Systolic Blood Pressure for 12 Week Double-Blind Treatment Period - Randomized ParticipantsBaseline to Week 12

Systolic blood pressure (SBP) was measured in millimeters of mercury (mmHg) on Day -1, Day 1, Weeks 2, 4, 8, and 12 of the Double Blind Period. Blood pressure (BP) values were obtained after the participant was seated for quietly for 10 minutes; a mean of 3 replicate measurements was taken at least 1 minute apart. However, if the 3 consecutive seated BP readings were not within 8 mm Hg of each other, an additional 2 BP readings were obtained (total = 5) and incorporated into the calculated mean. BP was measured in both arms. If the BP was higher in one arm than the other, then this arm was used; if no difference, the participant's dominant arm was used for all future BP measurements. Baseline was defined as the last assessment prior to the start date and time of the first dose of the double-blind study medication. Participants refrained from ingestion of caffeine, alcohol, or nicotine at least 10 hours prior to their visit and having their BP measured.

Adjusted Mean Change From Baseline in Hemoglobin A1c (HbA1c) for 12 Week Double-Blind Treatment Period - Randomized ParticipantsBaseline to Week 12

Adjusted mean change in glycosylated hemoglobin ( HbA1c) from baseline at Week 12 was calculated. HbA1c was measured as percent of hemoglobin by a central laboratory. Baseline was defined as the last assessment prior to the start date and time of the first dose of the double-blind study medication. HbA1c values were obtained at enrollment and lead-in (Day -28) periods, and at Day 1, Weeks 4, 8, and 12, in the double-blind period.

Secondary Outcome Measures
NameTimeMethod
Adjusted Mean Change From Baseline in 24-hour Ambulatory Systolic Blood Pressure at Week 12 Last Observation Carried Forward (LOCF)Baseline, Week 12

Ambulatory 24 hour (hr) blood pressure monitoring (ABPM) was performed at baseline, which was during the lead-in period (between Day -7 and Day -1 prior to randomization) and 1 week prior to the Week 12 visit/end of treatment visit. If no Week 12 measurement was available, the last available earlier post-baseline measurement was used (LOCF) for analysis. Initiation of the 24-hr ABPM began between 6am and 11am to ensure trough BP measurements were obtained.The ABPM units were calibrated, and used per the manufacturer's and central ABPM vendor instructions. BP was measured in mmHg. Participants had to have a mean 24-hour ABPM ≥ 130/80 mmHg prior to randomization. All medication was withheld on the morning of the study visit and brought to the visit site by the participant. Once the ABPM cuff was in place, all morning medication was taken while at the site.

Adjusted Mean Change From Baseline in Seated Diastolic Blood Pressure (DBP) for 12 Week Double-Blind Treatment Period - Randomized ParticipantsBaseline to Week 12

Diastolic BP was measured in millimeters of mercury (mmHg) on Day -1, Day 1, Weeks 2, 4, 8, and 12 of the Double Blind Period. Diastolic BP values were obtained after the participant was seated for quietly for 10 minutes; a mean of 3 replicate measurements was taken at least 1 minute apart. However, if the 3 consecutive seated BP readings were not within 8 mm Hg of each other, an additional 2 BP readings were obtained (total = 5) and incorporated into the calculated mean. BP was measured in both arms. If the pressure was higher in one arm than the other, then this arm was used; if no difference, the participant's dominant arm was used for all future BP measurements. Baseline was defined as the last assessment prior to the start date and time of the first dose of the double-blind study medication. Participants refrained from ingestion of caffeine, alcohol, or nicotine at least 10 hours prior to their visit and having their BP measured.

Adjusted Mean Change From Baseline in 24-hr Ambulatory Diastolic Blood Pressure at Week 12 (LOCF)Baseline, Week 12

Ambulatory 24 hour (hr) BP monitoring (ABPM) was performed at baseline, which was during the lead-in period (between Day -7 and Day -1 prior to randomization) and 1 week prior to the Week 12 visit/end of treatment visit. If no Week 12 measurement was available, the last available earlier post-baseline measurement was used (LOCF). Initiation of the 24-hr ABPM began between 6am and 11am to ensure trough BP measurements were obtained. The ABPM units were calibrated, and used per the manufacturer's and central ABPM vendor instructions. BP was measured in mmHg. Participants had to have a mean 24-hour ABPM ≥ 130/80 mmHg prior to randomization. All medication was withheld on the morning of the study visit and brought to the visit site by the participant. Once the ABPM cuff was in place, all morning medication was taken while at the site.

Adjusted Mean Change From Baseline in Serum Uric Acid at Week 12 in Double-Blind Treatment Period - Randomized ParticipantsBaseline, Week 12

Adjusted mean change in serum uric acid from baseline at Week 12 was calculated. Serum uric acid was measured in milligrams per deciliter (mg/dL) by a central laboratory. Baseline was defined as the last assessment prior to the start date and time of the first dose of the double-blind study medication. Serum uric acid measurements were obtained at qualification and lead-in (Day -28) periods, and at Day 1, Weeks 4, 8, and 12, in the double-blind period but only the change from baseline at Week 12 was considered a secondary endpoint and is presented.

Number of Participants With Deaths,Serious Adverse Events (SAEs), Adverse Events (AEs), Hypoglycemia Events, Discontinuation Due to AEs, SAEs and Hypoglycemia, During the 12 Week Double Blind Period, Including Data After RescueBaseline to last dose of 12 weeks of double blind medication plus 30 days if SAE or plus 4 days if AE/hypoglycemic event

Medical Dictionary for Regulatory Activities (MedDRA), version 15.1 AE=any new unfavorable symptom, sign, or disease or worsening of a preexisting condition that may not have a causal relationship with treatment. SAE=a medical event that at any dose results in death, persistent or significant disability/incapacity, or drug dependency/abuse; is life-threatening, an important medical event, or a congenital anomaly/birth defect; or requires or prolongs hospitalization. Related=having certain, probable, possible, or missing relationship to study drug as per the investigator. Events captured from baseline to last double blind dose plus 4 days for AEs, plus 30 days for SAEs during the Double Blind 12 Week Period. Only hypoglycemia reported as an SAE is included in AE/SAE categories . All reported hypoglycemia events within 4 days of last day of treatment are included as hypoglycemic events.

Number of Participants With Marked Chemistry Laboratory Abnormalities in 12 Week Double Blind Treatment Period, Including Data After RescueBaseline (Day 1) to last dose double blind medication (Week 12) plus 4 days

Samples obtained: Day 1, Weeks 4, 8,12 in Double Blind Period. Baseline: last assessment prior to start of first dose of double-blind treatment. Pretreatment (PreRX); grams per deciliter (g/dL); upper limit of normal (ULN); milliequivalent per liter (mEq/L); greater than (\>) less than (\<); Units per liter (U/L), Marked abnormality Low (High): hemoglobin \<6 (\>18 females or \>20 males) g/dL; creatinine (\>=1.5\*preRX, \>=2.5 mg/dL); glucose \< 54 or (\> 350) mg/dL; albumin \<= 2 or (\> 6) g/dL; creatine kinase \>5\*ULN; albumin/creatinine ratio (\>1800 mg/G); calcium \<7.5 (\>1 and \>0.5 from PreRX) mg/dL; bicarbonate \<=13 meq/dL; potassium \<=2.5 (\>6) meq/L; magnesium \<1 (\>4) mEq/L; sodium \< 130 mEq/L (\>150 mEq/L; phosphorus (\>=5.6 mg/dL age 17-65, \>=5.1 is \>=66 years); Albumin/creatinine ratio (\>1800 mg/g). Note: Hepatic tests are presented separately in next outcome measure.

Number of Participants With Elevated Liver Laboratory Tests in Participants Treated With Double Blind 10 mg Dapagliflozin or Placebo , Including Data After RescueBaseline (Day 1) to last dose double blind medication (Week 12) Plus 30 days

Laboratories were obtained at Day 1, Weeks 4, 8 and 12 in the Double Blind Period. Baseline: last assessment prior to start of first dose of double-blind treatment. Includes laboratory values measured after the first date of double-blind treatment and up to and including the last day of double blind treatment plus 30 days. Upper limit of normal (ULN);, alanine aminotransferase (ALT); aspartate aminotransferase (AST); alkaline phosphatase (ALP). Marked abnormality (High): AST and ALT (\>3\*ULN); ALP (\>1.5\*ULN); bilirubin (\>1.5\*ULN). Participants with abnormally elevated liver laboratory tests were followed 30 days after the last dose of study drug.

Number of Participants With Normal or Abnormal Electrocardiogram Summary Tracing at Week 12 (LOCF), Including Data After RescueBaseline, Week 12

12-Lead electrocardiograms (ECGs) were performed at Enrollment, Day 1 of Double Blind Period and Week 12/End of treatment visit (last observation carried forward) on participants who were supine. ECGs were assessed by the investigator as normal or abnormal. Baseline (BL) was Day 1 prior to dosing or last observation prior to dosing.

Proportion of Participants With Orthostatic Hypotension at Baseline and Week 12, Including Data After RescueBaseline (Day 1), Week 12

Orthostatic hypotension was defined as a decrease from supine to standing of \> 20 mmHg in systolic BP or \>10 mmHg in diastolic BP. Proportion was calculated from number of participants with orthostatic hypotension (n) divided by the number of treated participants (N). n/N presented as a percent (%). Baseline was Day 1 of the double blind Period. Measurements for orthostatic hypotension were taken on Day 1 and at Week 12 visit and does not reflect AEs reported by the investigator.

Trial Locations

Locations (155)

Abington Memorial Hos/Feasterville Family Health Care Center

🇺🇸

Feasterville, Pennsylvania, United States

The Clinical Trial Center, Llc

🇺🇸

Jenkintown, Pennsylvania, United States

Research Across America

🇺🇸

Reading, Pennsylvania, United States

Pish Medical Associates

🇺🇸

Uniontown, Pennsylvania, United States

Greater Providence Clinical Research, Llc

🇺🇸

Warwick, Rhode Island, United States

North Myrtle Beach Family Practice

🇺🇸

North Myrtle Beach, South Carolina, United States

Southwind Medical Specialists

🇺🇸

Memphis, Tennessee, United States

Integrated Research Group, Inc.

🇺🇸

Riverside, California, United States

Mcs Clinical Trials

🇺🇸

Los Angeles, California, United States

Clinical Research Advantage/Desert Clinical Research

🇺🇸

Tempe, Arizona, United States

Neurological Research Institute

🇺🇸

Santa Monica, California, United States

Orange County Research Center

🇺🇸

Tustin, California, United States

Orrin M. Troum, Md And Medical Associates

🇺🇸

Santa Monica, California, United States

International Research Associates, Llc

🇺🇸

Hialeah, Florida, United States

University Clinical Investigators, Inc.

🇺🇸

Tustin, California, United States

Palm Springs Research Institute

🇺🇸

Hialeah, Florida, United States

Central Florida Internists

🇺🇸

Kissimmee, Florida, United States

River Birch Research Alliance, Llc

🇺🇸

Blue Ridge, Georgia, United States

Medical Development Centers, Llc

🇺🇸

Baton Rouge, Louisiana, United States

Philadelphia Health Associates - Adult Medicine

🇺🇸

Philadelphia, Pennsylvania, United States

Perimeter Institute For Clinical Research

🇺🇸

Atlanta, Georgia, United States

Clinical Research Of Miami, Inc.

🇺🇸

Miami, Florida, United States

Flcri Global Research, Llc

🇺🇸

Miami, Florida, United States

Pharmax Research Clinic, Inc.

🇺🇸

Miami, Florida, United States

Community Research Foundation, Inc.

🇺🇸

Miami, Florida, United States

Baptist Diabetes Associates, Pa

🇺🇸

Miami, Florida, United States

3rd Coast Research Associates

🇺🇸

Corpus Christi, Texas, United States

Wetlin Research Associates, Inc.

🇺🇸

San Diego, California, United States

Office Of Ted Thorp, Md

🇺🇸

Las Vegas, Nevada, United States

Independent Clinical Researchers@ Wolfson Medical Center

🇺🇸

Las Vegas, Nevada, United States

Clinical Research Advantage, Inc.

🇺🇸

Las Vegas, Nevada, United States

Palm Medical Research Center

🇺🇸

Las Vegas, Nevada, United States

Community Research

🇺🇸

Cincinnati, Ohio, United States

Krk Medical Research

🇺🇸

Dallas, Texas, United States

Renaissance Clinical Research And Hypertension Pllc

🇺🇸

Dallas, Texas, United States

Internal Medicine Clinical Reaseach

🇺🇸

Dallas, Texas, United States

Sergio F. Rovner, M.D.

🇺🇸

El Paso, Texas, United States

Pioneer Research Solutions, Inc.

🇺🇸

Houston, Texas, United States

Lisa E. Medwedeff, Md, Pa

🇺🇸

Plano, Texas, United States

Exodus Healthcare Network

🇺🇸

Magna, Utah, United States

Manassas Clinical Research Center

🇺🇸

Manassas, Virginia, United States

Lillestol Research

🇺🇸

Fargo, North Dakota, United States

Phillips Medical Services, Pllc

🇺🇸

Jackson, Mississippi, United States

Preferred Research Partners, Inc.

🇺🇸

Little Rock, Arkansas, United States

Southeastern Research Associates, Inc.

🇺🇸

Greenville, South Carolina, United States

Visions Clinical Research - Tucson

🇺🇸

Tucson, Arizona, United States

The Center For Clinical Trials

🇺🇸

Biloxi, Mississippi, United States

Aureus Research, Inc.

🇺🇸

Little Rock, Arkansas, United States

Comprehensive Clinical Research

🇺🇸

Berlin, New Jersey, United States

Christiana Care Health Services, Inc

🇺🇸

Newark, Delaware, United States

Hillcrest Clinical Reseach, Llc

🇺🇸

Simpsonville, South Carolina, United States

Tn Medical Research

🇺🇸

Spring Hill, Tennessee, United States

Pawleys Pediatrics And Adult Medicine

🇺🇸

Pawleys Island, South Carolina, United States

Clin Research Advantage, Inc. James Meli, Do Family Pracice

🇺🇸

Henderson, Nevada, United States

Dependable Clinical Research, Llc

🇺🇸

Houston, Texas, United States

Palmetto Clinical Research

🇺🇸

Summerville, South Carolina, United States

Arlington Family Research Center, Inc.

🇺🇸

Arlington, Texas, United States

Hill Country Medical Associates

🇺🇸

New Braunfels, Texas, United States

Research Institute Of Dallas

🇺🇸

Dallas, Texas, United States

Village Family Practice

🇺🇸

Houston, Texas, United States

North Hills Medical Research, Inc.

🇺🇸

North Richland Hills, Texas, United States

Med-Olam Clinical Research

🇺🇸

Pasadena, Texas, United States

Bellaire Medical Care Group

🇺🇸

Houston, Texas, United States

Breco Research, Ltd

🇺🇸

Sugarland, Texas, United States

Millennium Clinical Trials Llc

🇺🇸

Arlington, Virginia, United States

Burke Internal Medicine And Research

🇺🇸

Burke, Virginia, United States

Hampton Roads Center For Clinical Research, Inc.

🇺🇸

Suffolk, Virginia, United States

Local Institution

🇬🇧

Bath, Wiltshire, United Kingdom

Eclipse Clinical Research

🇺🇸

Tucson, Arizona, United States

Medical Affiliated Research Center, Inc.

🇺🇸

Huntsville, Alabama, United States

Bayview Research Group, Llc

🇺🇸

Paramount, California, United States

Central Phoenix Medical Center

🇺🇸

Tempe, Arizona, United States

Clinical Research Advantage, Inc./Mesa Family Med Ctr, Pc

🇺🇸

Tempe, Arizona, United States

Cmp Research

🇺🇸

Anaheim, California, United States

Randall G. Shue, D.O.

🇺🇸

Los Angeles, California, United States

Catalina Research Institute, Llc

🇺🇸

Chino, California, United States

Sds Clinical Trials

🇺🇸

Orange, California, United States

Southland Clinical Research Center, Inc.

🇺🇸

Fountain Valley, California, United States

Clinica Medica San Miguel

🇺🇸

Los Angeles, California, United States

National Research Inst

🇺🇸

Los Angeles, California, United States

Time Clinical Research Inc.

🇺🇸

Huntington Park, California, United States

Torrance Clinical Research

🇺🇸

Torrance, California, United States

San Diego Managed Care Group

🇺🇸

Poway, California, United States

Ocean Blue Medical Research Center, Inc.

🇺🇸

Miami Springs, Florida, United States

Crest Clinical Trials, Inc.

🇺🇸

Santa Ana, California, United States

Chase Medical Research, Llc

🇺🇸

Waterbury, Connecticut, United States

Innovative Research Of West Florida, Inc

🇺🇸

Clearwater, Florida, United States

Zasa Clinical Research

🇺🇸

Boynton Beach, Florida, United States

So. Illinois Clin Res Ctr @ Div Of Kevin L Pritchett Md, Pc

🇺🇸

O?Fallon, Illinois, United States

The Community Research Of South Florida

🇺🇸

Hialeah, Florida, United States

Newphase Clinical Trials, Inc.

🇺🇸

Miami Beach, Florida, United States

Acadia Clinical Research, Llc

🇺🇸

Bangor, Maine, United States

Bainbridge Medical Associates

🇺🇸

Bainbridge, Georgia, United States

Suncoast Clinical Research, Inc.

🇺🇸

New Port Richey, Florida, United States

In-Quest Medical Research, Llc

🇺🇸

Duluth, Georgia, United States

Cedar Crosse Research Center

🇺🇸

Chicago, Illinois, United States

American Health Network Of In Llc

🇺🇸

Muncie, Indiana, United States

Hci-Metromedic Walk-In Medical Office

🇺🇸

New Bedford, Massachusetts, United States

Middle Georgia Drug Study Center, Llc

🇺🇸

Perry, Georgia, United States

Springfield Diabetes And Endocrine Center

🇺🇸

Springfield, Illinois, United States

Community Health Care, Inc.

🇺🇸

Canal Fulton, Ohio, United States

American Health Network Of Indiana Llc

🇺🇸

Avon, Indiana, United States

Laporte County Institute For Clinical Research, Inc.

🇺🇸

Michigan City, Indiana, United States

Omega Clinical Research, Llc

🇺🇸

Metairie, Louisiana, United States

Investigators Research Group, Llc

🇺🇸

Brownsburg, Indiana, United States

Providence Park Clinical Research

🇺🇸

Novi, Michigan, United States

Neurocare, Inc.

🇺🇸

Newton, Massachusetts, United States

Southgate Medical Group

🇺🇸

West Seneca, New York, United States

Atlantic Clinical Trials, Llc

🇺🇸

Watertown, Massachusetts, United States

Medex Healthcare Research, Inc.

🇺🇸

New York, New York, United States

Clinical Research Source, Inc

🇺🇸

Perrysburg, Ohio, United States

Parsons Avenue Medical Clinical

🇺🇸

Columbus, Ohio, United States

Southwest Clinical Trials

🇺🇸

Houston, Texas, United States

Excel Clinical Research, Llc

🇺🇸

Houston, Texas, United States

Arcuri Clinical Research Llc

🇺🇸

Philadelphia, Pennsylvania, United States

University Of Alabama At Birmingham

🇺🇸

Birmingham, Alabama, United States

43rd Medical Associates

🇺🇸

Phoenix, Arizona, United States

Sooner Clinical Research

🇺🇸

Oklahoma City, Oklahoma, United States

Sun Research Institute

🇺🇸

San Antonio, Texas, United States

Abbott Clinical Research Group, Inc.

🇺🇸

San Antonio, Texas, United States

Covenant Clinical Research, Pa

🇺🇸

San Antonio, Texas, United States

Innovative Clinical Trials

🇺🇸

San Antonio, Texas, United States

Wasatch Endocrinology And Diabetes Specialists

🇺🇸

Salt Lake City, Utah, United States

Wasatch Clinical Research

🇺🇸

Salt Lake City, Utah, United States

Jefferson City Medical Group

🇺🇸

Jefferson City, Missouri, United States

Apf Research, Llc

🇺🇸

Miami, Florida, United States

Alexandria Health Care Center

🇺🇸

Alexandria, Virginia, United States

Sound Medical Research

🇺🇸

Port Orchard, Washington, United States

Larry D. Stonesifer, Md

🇺🇸

Federal Way, Washington, United States

Clinical Investigation Specialists, Inc.

🇺🇸

Kenosha, Wisconsin, United States

Wilmax Clinical Research, Inc.

🇺🇸

Mobile, Alabama, United States

Del Rosario Medical Clinic, Inc.

🇺🇸

Huntington Park, California, United States

Marin Endocrine Care & Research, Inc.

🇺🇸

Greenbrae, California, United States

American Institute Of Research

🇺🇸

Los Angeles, California, United States

Diabetes Medical Center Of California

🇺🇸

Northridge, California, United States

Valley Clinical Trials

🇺🇸

Northridge, California, United States

Lucita M. Cruz,Md.,Inc.

🇺🇸

Norwalk, California, United States

Bradenton Research Center, Inc.

🇺🇸

Bradenton, Florida, United States

Clinical Research Of South Florida

🇺🇸

Coral Gables, Florida, United States

Michele A. Morrison Internal Medicine, Inc.

🇺🇸

Pembroke Pines, Florida, United States

Avail Clinical Research, Llc

🇺🇸

Deland, Florida, United States

Medsol Clinical Research Center

🇺🇸

Port Charlotte, Florida, United States

Digiovanna Institute For Medical Education & Research

🇺🇸

North Massapequa, New York, United States

Diabetes & Endocrinology Consultants

🇺🇸

Morehead City, North Carolina, United States

Burke Primary Care

🇺🇸

Morganton, North Carolina, United States

Willamette Valley Clinical Studies

🇺🇸

Eugene, Oregon, United States

Southeastern Pa Medical Institute

🇺🇸

Broomall, Pennsylvania, United States

Florida Institute For Clinical Research, Llc

🇺🇸

Orlando, Florida, United States

Meridien Research

🇺🇸

Tampa, Florida, United States

Kcumb Dybedal Clinical Research Center

🇺🇸

Kansas City, Missouri, United States

Medical Research South

🇺🇸

Charleston, South Carolina, United States

Quality Control Research, Inc

🇺🇸

Sacramento, California, United States

Alternative Primary Care

🇺🇸

Silver Spring, Maryland, United States

Premier Research

🇺🇸

Trenton, New Jersey, United States

Integris Family Care Yukon

🇺🇸

Yukon, Oklahoma, United States

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