Provider First Line Business Practice Location Address: 
1012 LAUREL OAK RD
    Provider Second Line Business Practice Location Address: 
CHOP CARE NETWORK AT VOORHEES SPECIALTY CARE
    Provider Business Practice Location Address City Name: 
VOORHEES
    Provider Business Practice Location Address State Name: 
NJ
    Provider Business Practice Location Address Postal Code: 
08043-3505
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
856-435-0086
    Provider Business Practice Location Address Fax Number: 
856-435-0091
    Provider Enumeration Date: 
08/07/2006