Provider First Line Business Practice Location Address:
100 NICOLLS ROAD
Provider Second Line Business Practice Location Address:
UNIVERSITY HOSPITAL AT STONY BROOK
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-9024
Provider Business Practice Location Address Fax Number:
631-444-3424
Provider Enumeration Date:
08/21/2006