Provider First Line Business Practice Location Address:
135 S WAKEA AVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732-1385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-276-2092
Provider Business Practice Location Address Fax Number:
808-242-9398
Provider Enumeration Date:
11/26/2012