Provider First Line Business Practice Location Address:
81-980 HALEKII ST
Provider Second Line Business Practice Location Address:
ROOM 101-HAWAII FGC-KONA
Provider Business Practice Location Address City Name:
KEALAKEKUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96750-8177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-322-1541
Provider Business Practice Location Address Fax Number:
808-322-1543
Provider Enumeration Date:
11/18/2011