Provider First Line Business Practice Location Address:
NICOLLS RD AND HEALTH SCIENCES DR INTERSECTION
Provider Second Line Business Practice Location Address:
STONY BROOK UNIVERSITY HOSPITAL, HSC T18-020
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-1045
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2006