Provider First Line Business Practice Location Address:
39 ALA MALAMA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAUNAKAKAI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-880-3321
Provider Business Practice Location Address Fax Number:
808-475-0061
Provider Enumeration Date:
05/10/2023