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1821724543
BASIL BENNETT
LOGAN, WV
NPI
1821724543
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
175T00000X Peer Specialist
(Licence: WV 0072)
Enumeration Date
2022-07-26
Last Update Date
2022-07-26
Business Address
BASIL BENNETT
174 LMAH CENTER RD
LOGAN, WV 25601-4058
Phone number: 304-792-7130
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Mailing Address
BASIL BENNETT
PO BOX 176
LOGAN, WV 25601-0176
Phone number: 304-792-7130
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