Provider First Line Business Practice Location Address:
850 KAMEHAMEHA HWY
Provider Second Line Business Practice Location Address:
ROOM 110
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-455-4173
Provider Business Practice Location Address Fax Number:
808-455-3280
Provider Enumeration Date:
09/21/2006