Provider First Line Business Practice Location Address:
17-4205 13 MILE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KURTISTOWN
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-966-7154
Provider Business Practice Location Address Fax Number:
808-974-7757
Provider Enumeration Date:
04/26/2007