Provider First Line Business Practice Location Address:
65-1292 KAWAIHAE RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-494-0197
Provider Business Practice Location Address Fax Number:
808-887-1373
Provider Enumeration Date:
05/22/2008