Provider First Line Business Practice Location Address:
IRONWOOD CENTER SUITE 106
Provider Second Line Business Practice Location Address:
64-5193 KINOHOU STREET
Provider Business Practice Location Address City Name:
KAMUELA
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:
808-333-7647
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2019