Provider First Line Business Practice Location Address:
94-366 PUPUPANI ST
Provider Second Line Business Practice Location Address:
SUITE 209A
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-842-7634
Provider Business Practice Location Address Fax Number:
808-842-7640
Provider Enumeration Date:
03/11/2008