Provider First Line Business Practice Location Address:
17-468 NORTH ALA ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KURTISTOWN
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96760-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-966-6145
Provider Business Practice Location Address Fax Number:
808-443-0276
Provider Enumeration Date:
06/25/2009