Provider First Line Business Practice Location Address:
205 N. BELLE MEADE RD
Provider Second Line Business Practice Location Address:
STONY BROOK UNIVERSITY MEDICAL CENTER PRIMARY CARE
Provider Business Practice Location Address City Name:
SETAUKET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11733-9252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-4715
Provider Business Practice Location Address Fax Number:
631-444-4695
Provider Enumeration Date:
09/08/2005