Provider First Line Business Practice Location Address:
98-1238 KAAHUMANU ST
Provider Second Line Business Practice Location Address:
STE 405
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-3291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-689-8811
Provider Business Practice Location Address Fax Number:
808-689-0316
Provider Enumeration Date:
10/18/2006