Provider First Line Business Practice Location Address:
3550 MARKET ST FL 2
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF PHILADELPHIA - DERMATOLOGY DIV
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-9119
Provider Business Practice Location Address Fax Number:
215-590-4948
Provider Enumeration Date:
07/31/2006