Provider First Line Business Practice Location Address:
94-1080 LUMIPOLU 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:
96797-3954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-265-8836
Provider Business Practice Location Address Fax Number:
727-592-5395
Provider Enumeration Date:
01/02/2026