Provider First Line Business Practice Location Address:
3401 MARKET STREET
Provider Second Line Business Practice Location Address:
SUITE 110 PENN DENTAL AT UNIVERSITY CITY
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-6228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-573-8400
Provider Business Practice Location Address Fax Number:
215-573-5550
Provider Enumeration Date:
01/09/2009