Provider First Line Business Practice Location Address:
1173 21ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816-4637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-733-2031
Provider Business Practice Location Address Fax Number:
808-733-2462
Provider Enumeration Date:
09/21/2006