Organization
VICTORY LIFE HEALTH SERVICES
Active
Other names
The Bridge into Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARISA TERRY (OWNER)
(716) 456-1225
Entity
Organization
Contact information
Practice address
95 E HIGH ST STE 104, WAYNESBURG, PA 15370-1853
(716) 456-1225
Mailing address
6221 ROUTE 474, ASHVILLE, NY 14710-9788
(716) 782-4158
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
04/06/2016
Last updated
04/06/2016
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