Provider First Line Business Practice Location Address:
379 KAMEHAMEHA HWY
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-3258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-486-7567
Provider Business Practice Location Address Fax Number:
808-486-7567
Provider Enumeration Date:
06/24/2010