Provider First Line Business Practice Location Address:
94-1020 HAPAPA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-3735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-671-0756
Provider Business Practice Location Address Fax Number:
808-671-0756
Provider Enumeration Date:
01/17/2014