Provider First Line Business Practice Location Address:
5633 KAWAIHAU ROAD
Provider Second Line Business Practice Location Address:
BLDG 2A-12
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-378-4477
Provider Business Practice Location Address Fax Number:
808-632-0033
Provider Enumeration Date:
09/11/2020