Provider First Line Business Practice Location Address:
161 S. WAKEA AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-244-7469
Provider Business Practice Location Address Fax Number:
808-242-4762
Provider Enumeration Date:
06/04/2009