| NPI | 1588869515 |
|---|---|
| Doing Business As | GLENN AVE FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | KRISTIN A HOLLISTER Assistant Practice Manager 570-387-2166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2020-08-22 |