Provider First Line Business Practice Location Address:
203 HO'OHANA STREET
Provider Second Line Business Practice Location Address:
MAUI CBOC
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-871-2454
Provider Business Practice Location Address Fax Number:
808-871-2106
Provider Enumeration Date:
05/17/2006