Provider First Line Business Practice Location Address:
4473 PAHEE ST
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
LIHUE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96766-2037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-245-6363
Provider Business Practice Location Address Fax Number:
808-245-6952
Provider Enumeration Date:
09/14/2010