Provider First Line Business Practice Location Address:
72-3996 PU'U KALA ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAILUA-KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-229-8957
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2025