Provider First Line Business Practice Location Address:
96-1100 KAMANI STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAHALA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96777-0067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-987-7490
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2006