Provider First Line Business Practice Location Address:
94-229 WAIPAHU DEPOT ROAD
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-678-3661
Provider Business Practice Location Address Fax Number:
808-678-3662
Provider Enumeration Date:
10/17/2006