Provider First Line Business Practice Location Address:
94-1030 WAIPIO UKA ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-4084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-671-7887
Provider Business Practice Location Address Fax Number:
808-671-7887
Provider Enumeration Date:
09/28/2006