Provider First Line Business Practice Location Address:
94-673 KUPUOHI STREET C108
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:
96797-5372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-686-9800
Provider Business Practice Location Address Fax Number:
808-484-5636
Provider Enumeration Date:
03/27/2009