Provider First Line Business Practice Location Address: 
3400 SPRUCE ST
    Provider Second Line Business Practice Location Address: 
2 SILVERSTEIN HOSPITAL OF UNIVERSITY OF PENNSYLVANIA
    Provider Business Practice Location Address City Name: 
PHILADELPHIA
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
19104-4238
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
215-349-8731
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/22/2014