Provider First Line Business Practice Location Address:
81-6224 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
B3
Provider Business Practice Location Address City Name:
CAPTAIN COOK
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96704-8111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-938-2260
Provider Business Practice Location Address Fax Number:
888-805-1547
Provider Enumeration Date:
04/30/2013