Provider First Line Business Practice Location Address:
221 MAHALANI STREET
Provider Second Line Business Practice Location Address:
PHYSICIAN PRACTICE SERVICES
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-442-5649
Provider Business Practice Location Address Fax Number:
808-442-5651
Provider Enumeration Date:
07/13/2005