Individual
MR. GLEN LAWRENCE COOPER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
BOX 530, ROUTE 130, HARRISON CITY, PA 15636
(724) 744-4471
(724) 744-1214
Mailing address
118 STONEYCREEK LN, HARRISON CITY, PA 15636-1308
(724) 744-4974
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
RT000248A
PA
Other
Enumeration date
12/21/2005
Last updated
07/08/2007
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