MR. Mark Wilson

NPI #1750736088 in Philadelphia, Pennsylvania

Provider Information

NPI Number: 1750736088
Entity Type: Individual
Name: MR. Mark Wilson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Clinic/Center
Enumeration Date: Apr 23, 2016
Last Updated: Apr 23, 2016

Practice Location

Address: 5313 OGDEN ST
City: Philadelphia
State: Pennsylvania
ZIP Code: 19139-1438
Phone: (215) 600-9477

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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