Provider First Line Business Practice Location Address:
94-801 FARRINGTON HWY
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:
96797-3164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-680-9123
Provider Business Practice Location Address Fax Number:
808-680-9889
Provider Enumeration Date:
07/22/2010