Provider First Line Business Practice Location Address:
472 KAULANA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732-2050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-877-2761
Provider Business Practice Location Address Fax Number:
808-871-9262
Provider Enumeration Date:
07/21/2005