Provider First Line Business Practice Location Address:
65-1230 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
SUITE C21
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-887-0033
Provider Business Practice Location Address Fax Number:
808-887-0035
Provider Enumeration Date:
06/19/2007