Provider First Line Business Practice Location Address:
94-1049 HALEAINA ST
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:
96797-5450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-778-2169
Provider Business Practice Location Address Fax Number:
808-688-0610
Provider Enumeration Date:
12/28/2006