Provider First Line Business Practice Location Address:
98-1238 KAAHUMANU ST
Provider Second Line Business Practice Location Address:
SUITE 404A
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-3250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-488-1990
Provider Business Practice Location Address Fax Number:
808-486-8495
Provider Enumeration Date:
10/10/2006