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1750736088
MARK WILSON
PHILADELPHIA, PA
NPI
1750736088
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
261Q00000X Clinic/Center
(Licence: PA A-6418104)
Enumeration Date
2016-04-23
Last Update Date
2016-04-23
Business Address
Mr. MARK WILSON
5313 OGDEN ST
PHILADELPHIA, PA 19139-1438
Phone number: 215-600-9477
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Mailing Address
Mr. MARK WILSON
5313 OGDEN ST
PHILADELPHIA, PA 19139-1438
Phone number: 215-600-9477
Copy
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