Provider First Line Business Practice Location Address:
2970 KELE ST
Provider Second Line Business Practice Location Address:
SUITE 113A
Provider Business Practice Location Address City Name:
LIHUE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96766-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-245-8024
Provider Business Practice Location Address Fax Number:
808-245-8165
Provider Enumeration Date:
07/08/2006