Provider First Line Business Practice Location Address:
45-3290 OHIA ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
HONOKAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96727-6931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-775-0814
Provider Business Practice Location Address Fax Number:
808-775-0645
Provider Enumeration Date:
05/19/2006