Provider First Line Business Practice Location Address:
94-1135 AWALAI 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:
96797-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-726-7378
Provider Business Practice Location Address Fax Number:
808-367-1413
Provider Enumeration Date:
09/21/2016