Provider First Line Business Practice Location Address:
4567 HAUAALA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-634-9379
Provider Business Practice Location Address Fax Number:
808-468-9976
Provider Enumeration Date:
06/04/2006