Provider First Line Business Practice Location Address:
65-1267 KAWAIHAE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-881-4658
Provider Business Practice Location Address Fax Number:
808-881-4684
Provider Enumeration Date:
11/06/2009