Provider First Line Business Practice Location Address:
75-5665 KUAKINI HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAILUA KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740-1689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-329-6997
Provider Business Practice Location Address Fax Number:
808-329-6987
Provider Enumeration Date:
02/17/2007