Provider First Line Business Practice Location Address:
1 JARRETT WHITE ROAD
Provider Second Line Business Practice Location Address:
PRDC, USA DENTAC HAWAII CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96859-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-1021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2006