Provider First Line Business Practice Location Address:
56-490 KAMEHAMEHA HWY
Provider Second Line Business Practice Location Address:
ROOM R104
Provider Business Practice Location Address City Name:
KAHUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96731-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-293-9216
Provider Business Practice Location Address Fax Number:
808-293-5390
Provider Enumeration Date:
01/10/2013