Provider First Line Business Practice Location Address:
850 KAM HWY
Provider Second Line Business Practice Location Address:
#215
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-456-5537
Provider Business Practice Location Address Fax Number:
808-455-6180
Provider Enumeration Date:
02/15/2007