Provider First Line Business Practice Location Address:
76-6225 KUAKINI HWY
Provider Second Line Business Practice Location Address:
STE B-203
Provider Business Practice Location Address City Name:
KAILUA KOMA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-329-6167
Provider Business Practice Location Address Fax Number:
808-334-0205
Provider Enumeration Date:
09/07/2006