Provider First Line Business Practice Location Address:
1126 12TH AVE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816-3715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-739-0704
Provider Business Practice Location Address Fax Number:
808-739-0704
Provider Enumeration Date:
12/05/2007