Provider First Line Business Practice Location Address:
56-119 PUALALEA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAHUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96731-2052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-293-9261
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2011