Provider First Line Business Practice Location Address:
81-6627 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
KEALAKEKUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96750-8180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-322-8005
Provider Business Practice Location Address Fax Number:
808-329-5057
Provider Enumeration Date:
10/28/2008