Provider First Line Business Practice Location Address:
34TH STREET & CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF PHILADELPHIA
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-906-2149
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2012