Provider First Line Business Practice Location Address:
94-1181 KA UKA BLVD.
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-260-9056
Provider Business Practice Location Address Fax Number:
808-444-8353
Provider Enumeration Date:
04/03/2019