Provider First Line Business Practice Location Address:
68-1845 WAIKOLOA ROAD
Provider Second Line Business Practice Location Address:
WAIKOLOA HIGHLANDS SHOPPING CENTER SUITE 224B
Provider Business Practice Location Address City Name:
WAIKOLOA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-883-0922
Provider Business Practice Location Address Fax Number:
808-883-1022
Provider Enumeration Date:
12/13/2006