Provider First Line Business Practice Location Address:
309 MARKET ST
Provider Second Line Business Practice Location Address:
SONRISA OLD CITY DENTAL ARTS, LLC
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-923-1881
Provider Business Practice Location Address Fax Number:
215-923-1336
Provider Enumeration Date:
05/24/2007