Provider First Line Business Practice Location Address:
94-216 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:
96797-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-589-1829
Provider Business Practice Location Address Fax Number:
808-589-2610
Provider Enumeration Date:
08/18/2008