Provider First Line Business Practice Location Address:
81-964 HALEKI'I ST
Provider Second Line Business Practice Location Address:
BLDG 4, SUITE C
Provider Business Practice Location Address City Name:
KEALAKEKUA
Provider Business Practice Location Address State Name:
HAWAII
Provider Business Practice Location Address Postal Code:
96750
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
808-339-7788
Provider Business Practice Location Address Fax Number:
808-339-7736
Provider Enumeration Date:
10/22/2013