Provider First Line Business Practice Location Address:
14-4515 A KAPOHO-HONOLULU LANDING ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAHOA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96778-7706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-687-4820
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2007