Provider First Line Business Practice Location Address:
5-1279 KAWAIHAE ROAD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WAIMEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-887-0747
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2018