Provider First Line Business Practice Location Address:
5282A KAWAIHAU RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-822-7955
Provider Business Practice Location Address Fax Number:
808-822-0009
Provider Enumeration Date:
03/10/2008