Provider First Line Business Practice Location Address:
KAPAA WAIVER PROGRAM SERVICE CENTER
Provider Second Line Business Practice Location Address:
4800 KAWAIHAU ROAD #F
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-821-6944
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2019