Provider First Line Business Practice Location Address:
55-510 KAM HWY
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
LAIE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-293-9500
Provider Business Practice Location Address Fax Number:
808-293-1890
Provider Enumeration Date:
09/07/2006