Provider First Line Business Practice Location Address:
74-5622 ALAPA ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
KAILUA KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-345-2429
Provider Business Practice Location Address Fax Number:
808-325-1313
Provider Enumeration Date:
05/22/2007