Provider First Line Business Practice Location Address:
4-1104 KUHIO HWY
Provider Second Line Business Practice Location Address:
#183
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-652-1962
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2008