Provider First Line Business Practice Location Address:
1144 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-737-3311
Provider Business Practice Location Address Fax Number:
808-737-3331
Provider Enumeration Date:
11/30/2009