Provider First Line Business Practice Location Address: 
ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
    Provider Second Line Business Practice Location Address: 
ERIE AVE AT FRONT STREET
    Provider Business Practice Location Address City Name: 
PHILADELPHIA
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
19134-1095
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
215-427-5220
    Provider Business Practice Location Address Fax Number: 
215-427-4339
    Provider Enumeration Date: 
10/25/2006