Provider First Line Business Practice Location Address:
34TH STREET & CIVIC CENTER BOULEVARD
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF PHILADELPHIA, CARDIAC CENTER
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:
267-239-7130
Provider Business Practice Location Address Fax Number:
215-590-6690
Provider Enumeration Date:
06/13/2007