Provider First Line Business Practice Location Address:
3400 CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
THE 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:
19104-5127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-426-5877
Provider Business Practice Location Address Fax Number:
215-590-3770
Provider Enumeration Date:
11/21/2014