Provider First Line Business Practice Location Address:
55-220 KULANUI ST
Provider Second Line Business Practice Location Address:
BYUH BOX #1916
Provider Business Practice Location Address City Name:
LAIE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96762-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-293-3510
Provider Business Practice Location Address Fax Number:
808-293-3506
Provider Enumeration Date:
08/31/2006