Provider First Line Business Practice Location Address:
MEDICAL STAFF OFFICE T14
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:
11794-7148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-2754
Provider Business Practice Location Address Fax Number:
631-444-6031
Provider Enumeration Date:
04/21/2009