Provider First Line Business Practice Location Address:
3535 MARKET ST. STE. 1371
Provider Second Line Business Practice Location Address:
CHOP ADOLESCENT INITIATIVE
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-5021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-3626
Provider Business Practice Location Address Fax Number:
215-590-0426
Provider Enumeration Date:
11/21/2005