Provider First Line Business Practice Location Address:
67-1123 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
SUSITE 128
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-885-9170
Provider Business Practice Location Address Fax Number:
808-885-1787
Provider Enumeration Date:
09/28/2006