Organization
ANCIENT WIDOM HEALING ARTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN WILSON BROUSSARD L. AC., M.T.O.M. (VICE PRESIDENT)
(443) 838-3141
Entity
Organization
Contact information
Practice address
658 KENILWORTH DR, SUITE #102, TOWSON, MD 21204-2312
(443) 838-3141
(410) 377-6168
Mailing address
918 WELLINGTON RD, BALTIMORE, MD 21212-1921
(443) 838-3141
(410) 377-6168
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
LIC # U01120
MD
Other
Enumeration date
02/12/2015
Last updated
02/12/2015
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