Provider First Line Business Practice Location Address:
4469 WAIALO RD., SUITE C9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELEELE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-378-4748
Provider Business Practice Location Address Fax Number:
808-320-3489
Provider Enumeration Date:
05/06/2010