Provider First Line Business Practice Location Address:
200 W. KAWILI ST
Provider Second Line Business Practice Location Address:
CAMPUS CENTER RM 212
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-932-7369
Provider Business Practice Location Address Fax Number:
808-932-7368
Provider Enumeration Date:
10/30/2009