Provider First Line Business Practice Location Address:
34TH STREET AND CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF PHILADELPHIA CSH RM 102
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-426-8784
Provider Business Practice Location Address Fax Number:
215-590-9338
Provider Enumeration Date:
03/10/2011