Provider First Line Business Practice Location Address:
94-436 APOWALE 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:
96797-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-255-4786
Provider Business Practice Location Address Fax Number:
808-443-0454
Provider Enumeration Date:
11/15/2011