Provider First Line Business Practice Location Address:
3059 UMI ST RM A-014
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:
96766-1396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-274-3883
Provider Business Practice Location Address Fax Number:
808-274-3889
Provider Enumeration Date:
07/23/2020