Provider First Line Business Practice Location Address:
54-010 KAMEHAMEHA HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAUULA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96717-9690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-397-0153
Provider Business Practice Location Address Fax Number:
808-470-2350
Provider Enumeration Date:
02/07/2023