Provider First Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF PHILADELPHIA, 5TH FLR WOOD BLDG
Provider Second Line Business Practice Location Address:
34TH ST & CIVIC CENTER BLVD
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-4684
Provider Business Practice Location Address Fax Number:
215-590-3500
Provider Enumeration Date:
05/23/2006