Provider First Line Business Practice Location Address:
604 S WASHINGTON SQ
Provider Second Line Business Practice Location Address:
DENTAL SUITE
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106-4118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-627-0777
Provider Business Practice Location Address Fax Number:
215-646-6166
Provider Enumeration Date:
01/04/2013