Provider First Line Business Practice Location Address:
4218 WAIALAE AVE
Provider Second Line Business Practice Location Address:
A106
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816-5321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-735-0007
Provider Business Practice Location Address Fax Number:
808-735-0021
Provider Enumeration Date:
05/08/2006