Individual
JEFFERSON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
909 WALNUT ST, SUITE 320L, PHILADELPHIA, PA 19107-5211
(215) 601-8976
Mailing address
909 WALNUT ST, SUITE 320L, PHILADELPHIA, PA 19107-5211
(215) 601-8976
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD454836
PA
Other
Enumeration date
08/16/2015
Last updated
08/16/2015
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