Provider First Line Business Practice Location Address:
270 WAIEHU BEACH RD
Provider Second Line Business Practice Location Address:
115
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-1472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-249-8784
Provider Business Practice Location Address Fax Number:
808-249-0536
Provider Enumeration Date:
02/09/2007