Provider First Line Business Practice Location Address:
1784 HOOHULU ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-456-8457
Provider Business Practice Location Address Fax Number:
808-455-2599
Provider Enumeration Date:
05/16/2007