Provider First Line Business Practice Location Address:
86-260 FARRINGTON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAINAE
Provider Business Practice Location Address State Name:
HAWAII
Provider Business Practice Location Address Postal Code:
96792
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
808-696-1444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2006