Provider First Line Business Practice Location Address:
77-6443 KUAKINI HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAILUA KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740-2227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-334-0900
Provider Business Practice Location Address Fax Number:
808-334-0930
Provider Enumeration Date:
01/20/2011