Provider First Line Business Practice Location Address:
HOSP OF THE UNIV OF PENNSYLVANIA, DEPT OF EMERG MED
Provider Second Line Business Practice Location Address:
3400 SPRUCE STREET, GRD FLR RAVDIN BLDG
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-6698
Provider Business Practice Location Address Fax Number:
215-662-3953
Provider Enumeration Date:
12/29/2011