Organization
VICTORY WELLNESS CENTER, LLC
Active
Other names
VICTORY WELLNESS CENTER, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
SUPORIOR R HARRIS CRNP (C.E.O./ CERTIFIED NURSE PRACTITIONE)
(251) 610-2644
Entity
Organization
Contact information
Practice address
123 CAILLAVET ST, BILOXI, MS 39530-4101
(228) 386-7487
(228) 386-7499
Mailing address
PO BOX 8556, BILOXI, MS 39535-8556
(251) 610-2644
(251) 639-9707
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
R866985
MS
Other
Enumeration date
01/26/2010
Last updated
01/26/2010
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