Provider First Line Business Practice Location Address:
C/O ISLAND OHANA DENTAL
Provider Second Line Business Practice Location Address:
101 AUPUNI ST, PH 1014-C
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-935-4800
Provider Business Practice Location Address Fax Number:
808-935-4870
Provider Enumeration Date:
06/15/2006