Provider First Line Business Practice Location Address:
STONY BROOK UNI HOSPITAL DEPT OF FAMILY MED
Provider Second Line Business Practice Location Address:
LEVEL 4, ROOM 050, HSC
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-8461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-8430
Provider Business Practice Location Address Fax Number:
631-444-7552
Provider Enumeration Date:
08/17/2014