Provider First Line Business Practice Location Address: 
3401 CIVIC CENTER BLVD
    Provider Second Line Business Practice Location Address: 
CHILDREN'S HOSPITAL OF PHILADELPHIA - CARDIOLOGY
    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: 
215-590-4040
    Provider Business Practice Location Address Fax Number: 
267-426-9800
    Provider Enumeration Date: 
07/24/2006