Organization
CITYLIFE-PA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM BRADLEY ROUSE (EVP)
(615) 708-4487
Entity
Organization
Contact information
Practice address
3945 CHESTNUT ST, 2ND FLOOR, PHILADELPHIA, PA 19104-3621
(267) 819-1800
Mailing address
2020 21ST AVE S, SUITE 202, NASHVILLE, TN 37212-4354
(615) 708-4487
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
08/05/2015
Last updated
08/05/2015
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