Provider First Line Business Practice Location Address:
4-1461 KUHIO HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746-1715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-822-4333
Provider Business Practice Location Address Fax Number:
808-822-0938
Provider Enumeration Date:
06/16/2005