Provider First Line Business Practice Location Address:
91-616 ONELUA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EWA BEACH
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96706-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-689-1937
Provider Business Practice Location Address Fax Number:
808-689-1933
Provider Enumeration Date:
04/24/2008