Provider First Line Business Practice Location Address:
3-3122 KUHIO HWY STE A15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIHUE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96766-1157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-246-9102
Provider Business Practice Location Address Fax Number:
808-246-8609
Provider Enumeration Date:
12/13/2016