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Managed Care Complimentary Inclusion Form

HcVN The World's Healthcare Village Network
offers complimentary listings in HcVN's TeleMedical Directory.

"Where the most powerful, innovative Search Engine Facility in the Internet originated."
"Full contact information-at-a-glance."

Establish a shining presence on the World Wide Web.
It is Convenient, Dynamic, Relevant. It is the right thing to do. Complete the form now.
Click on Register, or proceed to other Directories for multiple listings.

Managed Care Organization:
Address1:
Address2:
City:
State:
Province/Territory:
Zip:
Country:
Telephone:	(Only digits, () or - please)
Second Phone:	(Only digits, () or - please)
Video Conferencing No.:	(Only digits, () or - please)
Fax:	(Only digits, () or - please)
Contact:
Title:
Email:
Url:
Year Founded:
Federally Qualified:	Yes No
For Profit:	Yes No
Physicians:
Number of Hospitals:
PPO/HMO Number:
Types:
Current Enrollment:
Prescription Drug Benefit:
Areas Served:

Congratulations!
You have just unlocked your communications gateway to the world.

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