Provider First Line Business Practice Location Address:
SCHOOL OF DENTAL MEDICINE
Provider Second Line Business Practice Location Address:
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:
11794-8704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-632-8951
Provider Business Practice Location Address Fax Number:
631-632-9105
Provider Enumeration Date:
02/19/2007