Provider First Line Business Practice Location Address:
4491 KOLOPA ST STE A
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LIHUE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96766-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-246-9100
Provider Business Practice Location Address Fax Number:
808-246-9199
Provider Enumeration Date:
12/21/2005