Provider First Line Business Practice Location Address:
45-3310 OHAI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOKAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-210-4458
Provider Business Practice Location Address Fax Number:
808-482-8755
Provider Enumeration Date:
05/15/2026