Provider First Line Business Practice Location Address:
240 SOUTH 40TH STREET, OFFICE OF CLINICAL AFFAIRS-S6A E
Provider Second Line Business Practice Location Address:
UPENN 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:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-573-2588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2024