Provider First Line Business Practice Location Address:
3136 ELUA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIHUE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96766-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-245-1996
Provider Business Practice Location Address Fax Number:
808-246-6464
Provider Enumeration Date:
04/16/2013