Provider First Line Business Practice Location Address:
1150 NAKUI ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAKAWAO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-572-0969
Provider Business Practice Location Address Fax Number:
808-572-5073
Provider Enumeration Date:
01/05/2010