Provider First Line Business Practice Location Address:
65-1230 MAMALAHOA HWY STE E21
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:
96743-8319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-887-8801
Provider Business Practice Location Address Fax Number:
808-887-8805
Provider Enumeration Date:
09/24/2006