Provider First Line Business Practice Location Address:
2-4131 KAUMUALII HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWAI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-645-0742
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2006