Provider First Line Business Practice Location Address:
1130 N NIMITZ HWY
Provider Second Line Business Practice Location Address:
C301
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817-4579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-845-7771
Provider Business Practice Location Address Fax Number:
808-845-7955
Provider Enumeration Date:
05/10/2012