Provider First Line Business Practice Location Address:
3401 CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF PHILADELPHIA - GENERAL PEDS
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-2164
Provider Business Practice Location Address Fax Number:
215-590-2180
Provider Enumeration Date:
07/21/2009