Provider First Line Business Practice Location Address:
GPR PROGRAM, DENTAL CARE CENTER, SULLIVAN HALL
Provider Second Line Business Practice Location Address:
SUNY AT STONY BROOK
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-632-9245
Provider Business Practice Location Address Fax Number:
631-632-9701
Provider Enumeration Date:
05/27/2011