Provider First Line Business Practice Location Address:
47-669 MELEKULA RD
Provider Second Line Business Practice Location Address:
#10
Provider Business Practice Location Address City Name:
KANEOHE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-224-5008
Provider Business Practice Location Address Fax Number:
866-886-1743
Provider Enumeration Date:
10/21/2008