Provider First Line Business Practice Location Address:
15-2866 GOVT. ROAD PAHOA TOWN CENTER
Provider Second Line Business Practice Location Address:
BLDG. E
Provider Business Practice Location Address City Name:
PAHOA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-965-2240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2007