Provider First Line Business Practice Location Address:
399 S 34TH ST
Provider Second Line Business Practice Location Address:
PENN TOWER HOTEL--UPENN STUDENT HEALTH SERVICES
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-2874
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2007