Individual
GRACE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9005 CHEVROLET DR, ELLICOTT CITY, MD 21042-4009
(443) 538-0675
Mailing address
812 THE OLD STATION CT, WOODBINE, MD 21797-8760
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
U02473
MD
Other
Enumeration date
11/19/2018
Last updated
11/19/2018
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