Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jun 27, 2011
License(s)
R72495 (AZ), 18078 (HI), A128241 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 64-1032 MAMALAHOA HWY STE 306 | Kamuela, HI 96743-8441 | |
| LOCATION | 64-1032 MAMALAHOA HWY STE 306 | Kamuela, HI 96743-8441 | 808-769-5010 |
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