Provider First Line Business Practice Location Address:
13-5701 KALAPANA-KAPOHO RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAHOA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-778-9940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2019