Provider First Line Business Practice Location Address:
65-1206 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
BUILDING 2, #1
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-7303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-885-7986
Provider Business Practice Location Address Fax Number:
808-885-2095
Provider Enumeration Date:
03/05/2007