Provider First Line Business Practice Location Address:
4353 WAIALO ROAD
Provider Second Line Business Practice Location Address:
11A
Provider Business Practice Location Address City Name:
ELEELE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96705-0207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-335-5808
Provider Business Practice Location Address Fax Number:
808-335-5657
Provider Enumeration Date:
07/17/2009