Provider First Line Business Practice Location Address:
35-0471 HAWAII BELT ROAD
Provider Second Line Business Practice Location Address:
OLD LAUPAHOEHOE DISPENSARY
Provider Business Practice Location Address City Name:
LAUPAHOEHOE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-963-6101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2009