Provider First Line Business Practice Location Address:
3223 NORTH BROAD STREET
Provider Second Line Business Practice Location Address:
TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140-5007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-707-2979
Provider Business Practice Location Address Fax Number:
215-707-7616
Provider Enumeration Date:
02/10/2015