Provider First Line Business Practice Location Address:
110 ROCKLAND HALL-PERIODONTICS
Provider Second Line Business Practice Location Address:
SCHOOL OF DENTAL MEDICINE-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:
11794-8703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-632-8895
Provider Business Practice Location Address Fax Number:
631-632-3113
Provider Enumeration Date:
02/24/2007