Provider First Line Business Practice Location Address:
96-1115 KAMANI STREET
Provider Second Line Business Practice Location Address:
SUITE 36
Provider Business Practice Location Address City Name:
PAHALA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-928-6252
Provider Business Practice Location Address Fax Number:
808-928-6408
Provider Enumeration Date:
02/12/2007