Provider First Line Business Practice Location Address:
65-1229A OPELO RD.
Provider Second Line Business Practice Location Address:
HANA HOU COTTAGES #3
Provider Business Practice Location Address City Name:
KAMEULA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-895-0989
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2008