Provider First Line Business Practice Location Address:
4353 WAIALO RD
Provider Second Line Business Practice Location Address:
9B PORT ALLEN MARINA CENTER
Provider Business Practice Location Address City Name:
ELEELE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96702-0207
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:
09/16/2006