Provider First Line Business Practice Location Address:
SCHOOL OF DENTAL MEDICINE
Provider Second Line Business Practice Location Address:
STONY BROOK UNIVERSITY
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-8702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-632-8927
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2011