Provider First Line Business Practice Location Address:
1329 LUSITANA ST
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:
96813-2429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-531-7111
Provider Business Practice Location Address Fax Number:
808-528-5507
Provider Enumeration Date:
08/31/2006