Provider First Line Business Practice Location Address:
54-316 KAMEHAMEHA HWY
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
HAUULA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96717-9539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-293-5377
Provider Business Practice Location Address Fax Number:
808-293-5390
Provider Enumeration Date:
08/15/2007