| NPI | 1396210126 |
|---|---|
| Doing Business As | MIRACLE LEAF CORP |
| Entity Type | Organization |
| Authorized Contact | SOPHIA WEAVER Credentialer 813-679-5276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2018-10-08 |