Provider First Line Business Practice Location Address:
65-1230 MAMALAHOA HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE C 13/14
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-731-8641
Provider Business Practice Location Address Fax Number:
808-209-8210
Provider Enumeration Date:
07/19/2018