Provider First Line Business Practice Location Address:
94-1036 WAIPIO UKA 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:
96797-4050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-671-0564
Provider Business Practice Location Address Fax Number:
808-671-0564
Provider Enumeration Date:
03/14/2006