Provider First Line Business Practice Location Address:
240 SOUTH 40TH ST SUITE F-17
Provider Second Line Business Practice Location Address:
UNIVERSITY OF PENNSYLVANIA SCHOOL OF DENTAL MEDICINE
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-898-8979
Provider Business Practice Location Address Fax Number:
215-746-2060
Provider Enumeration Date:
07/11/2009