Provider First Line Business Practice Location Address:
3-3204 KUHIO HWY STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIHUE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96766-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-386-4860
Provider Business Practice Location Address Fax Number:
808-274-3889
Provider Enumeration Date:
04/23/2007