Provider First Line Business Practice Location Address:
4800 KAWAIHAU RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746-1964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-240-0140
Provider Business Practice Location Address Fax Number:
808-245-4146
Provider Enumeration Date:
12/20/2010