Provider First Line Business Practice Location Address:
NICOLLS ROAD
Provider Second Line Business Practice Location Address:
HSC T12 ROOM 020 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:
11794-8121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-2599
Provider Business Practice Location Address Fax Number:
631-444-4743
Provider Enumeration Date:
06/26/2007