Provider First Line Business Practice Location Address:
94-1030 WAIPIO UKA ST
Provider Second Line Business Practice Location Address:
SUITE 102
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:
808-671-6731
Provider Business Practice Location Address Fax Number:
808-676-5655
Provider Enumeration Date:
09/26/2006