Organization
VICTORY ATHLETIC EXCHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUSTIN JACOB CANDANOZA (EXECUTIVE DIRECTOR)
(424) 383-4905
Entity
Organization
Contact information
Practice address
3915 H ST APT D, VANCOUVER, WA 98663-1880
(360) 409-1031
Mailing address
3915 H ST APT D, VANCOUVER, WA 98663-1880
(360) 409-1031
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
10/16/2024
Last updated
10/16/2024
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