Provider First Line Business Practice Location Address:
59-210 ALA KAHUA DRIVE
Provider Second Line Business Practice Location Address:
KOHALA ESTATES
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-882-7890
Provider Business Practice Location Address Fax Number:
808-880-1790
Provider Enumeration Date:
01/16/2007