Provider First Line Business Practice Location Address:
79-7446 MAMALAHOA HWY BLDG A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEALAKEKUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96750-7913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-533-3936
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2014