Provider First Line Business Practice Location Address:
3401 CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
CHILDRENS HOSPITAL OF PHILADELPHIA CHCA GASTRO
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:
215-590-3247
Provider Business Practice Location Address Fax Number:
215-590-3606
Provider Enumeration Date:
01/14/2009