Provider First Line Business Practice Location Address:
2460 OKA ST
Provider Second Line Business Practice Location Address:
101-A
Provider Business Practice Location Address City Name:
KILAUEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96754-5308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-828-2882
Provider Business Practice Location Address Fax Number:
808-828-0119
Provider Enumeration Date:
06/13/2008