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1780908228
MIRACLE HEALTHCARE LLC
BOLIVAR, TN
NPI
1780908228
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Entity Type
Organization
Authorized Contact
LATOSHA MESSENGER
Owner
731-658-2885
Organization Subpart ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner Family
Enumeration Date
2010-03-25
Last Update Date
2010-03-25
Business Address
MIRACLE HEALTHCARE LLC
649B W MCNEAL ST
BOLIVAR, TN 38008-2519
Phone number: 731-658-2885
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Mailing Address
MIRACLE HEALTHCARE LLC
649B W MCNEAL ST
BOLIVAR, TN 38008-2519
Phone number: 731-658-2885
Copy
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