Provider First Line Business Practice Location Address:
11 MAHAOLU ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-871-5804
Provider Business Practice Location Address Fax Number:
808-877-4082
Provider Enumeration Date:
12/16/2008