Provider First Line Business Practice Location Address:
60 E WAKEA AVE
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732-2466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-871-4663
Provider Business Practice Location Address Fax Number:
808-893-2001
Provider Enumeration Date:
12/21/2005