Provider First Line Business Practice Location Address:
65 1298B KAWAIHAE ROAD
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:
96743-0729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-885-7719
Provider Business Practice Location Address Fax Number:
808-885-4450
Provider Enumeration Date:
11/15/2006