Provider First Line Business Practice Location Address:
66-437 KAMEHAMEHA HWY #95
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
HALEIWA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-518-4565
Provider Business Practice Location Address Fax Number:
805-222-3041
Provider Enumeration Date:
11/15/2016