Provider First Line Business Practice Location Address:
73-1041 AHIKAWA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAILUA KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740-9408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-936-1135
Provider Business Practice Location Address Fax Number:
808-325-5847
Provider Enumeration Date:
10/23/2009