Provider First Line Business Practice Location Address:
3-3420 KUHIO HWY STE B
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:
96766-1098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-245-1504
Provider Business Practice Location Address Fax Number:
808-246-1363
Provider Enumeration Date:
02/06/2015