Provider First Line Business Practice Location Address:
HSC 9TH FL. RM 065
Provider Second Line Business Practice Location Address:
STONY BROOK UNIVERSITY HOSPITAL
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-6907
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2005