Provider First Line Business Practice Location Address:
130 KAM V HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAUNAKAKAI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-553-9080
Provider Business Practice Location Address Fax Number:
808-553-3353
Provider Enumeration Date:
01/24/2007