Provider First Line Business Practice Location Address:
79-7393 MAMALAHOA HWY.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEALAKEKUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-345-4742
Provider Business Practice Location Address Fax Number:
808-339-7764
Provider Enumeration Date:
11/01/2019