Provider First Line Business Practice Location Address:
STONY BROOK UNIVERSITY 100 NICOLLS RD
Provider Second Line Business Practice Location Address:
SCHOOL OF DENTAL MEDICINE, 1105 WESTCHESTER HALL
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-8712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-939-4881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2013