| NPI | 1780285510 |
|---|---|
| Doing Business As | VICTORY SPINE AND SPORT |
| Entity Type | Organization |
| Authorized Contact | DUSTIN HENRY Owner 360-818-4626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2021-12-02 |