Provider First Line Business Practice Location Address:
407 ULUNIU ST STE 412
Provider Second Line Business Practice Location Address:
KAILUA MEDICAL ARTS BLDG
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-421-7753
Provider Business Practice Location Address Fax Number:
808-230-2476
Provider Enumeration Date:
07/11/2011