Provider First Line Business Practice Location Address:
149 HANA HWY
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
PAIA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96779-9745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-579-9750
Provider Business Practice Location Address Fax Number:
808-579-9751
Provider Enumeration Date:
11/03/2009