Provider First Line Business Practice Location Address:
81-6587 MAMALAHOA HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE C-201
Provider Business Practice Location Address City Name:
KEALAKEKUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-323-3107
Provider Business Practice Location Address Fax Number:
808-323-0012
Provider Enumeration Date:
05/17/2006