Provider First Line Business Practice Location Address:
135 S WAKEA AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-385-0051
Provider Business Practice Location Address Fax Number:
808-242-8920
Provider Enumeration Date:
10/16/2008