Provider First Line Business Practice Location Address:
16-1689 UAU STREET (5 ROAD)
Provider Second Line Business Practice Location Address:
HAWAIIAN ACRES SUBDIVISION
Provider Business Practice Location Address City Name:
KURTISTOWN
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96760-9676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-854-6138
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2023