Provider First Line Business Practice Location Address:
55-510 KAMEHAMEHA HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAIE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96762-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-225-4740
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2011