Provider First Line Business Practice Location Address:
65-1206 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
BLDG 3 UNIT 10
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:
808-775-7773
Provider Business Practice Location Address Fax Number:
360-944-3925
Provider Enumeration Date:
04/21/2011