Provider First Line Business Practice Location Address:
130 KAMEHAMEHA V HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAUNAKAKAI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96748-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-658-6930
Provider Business Practice Location Address Fax Number:
808-633-8535
Provider Enumeration Date:
07/31/2012