Well maintained & thoroughly cleaned after every use. Additional ear pieces included, never opened. It is an incredible stethoscope, just not one I really need now that school is over. The item "Littmann cardiology iv stethoscope" is in sale since Wednesday, November 08, 2017.This item is in the category "Business & Industrial\Healthcare, Lab & Life Science\Medical Instruments\Stethoscopes". The seller is "ondriars" and is located in Hillside, Illinois. This item can be shipped to United States.