Provider First Line Business Practice Location Address:
240 SOUTH 40TH STREET
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:
19105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-898-4615
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2008