Provider First Line Business Practice Location Address:
161 S WAKEA AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-532-0544
Provider Business Practice Location Address Fax Number:
360-532-0559
Provider Enumeration Date:
09/20/2006