Provider First Line Business Practice Location Address:
64-1032 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
UNIT 1A
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-887-1973
Provider Business Practice Location Address Fax Number:
808-881-8578
Provider Enumeration Date:
08/22/2007