Provider First Line Business Practice Location Address:
629 A KAILUA RD
Provider Second Line Business Practice Location Address:
RM #1
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-261-6685
Provider Business Practice Location Address Fax Number:
808-262-6438
Provider Enumeration Date:
03/06/2007