Provider First Line Business Practice Location Address:
STONY BROOK UNIVERSITY MEDICAL CTR
Provider Second Line Business Practice Location Address:
16S ROOM 087
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-7191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-2901
Provider Business Practice Location Address Fax Number:
631-444-8842
Provider Enumeration Date:
08/12/2011