Provider First Line Business Practice Location Address:
94 307 FARRINGTON HWY
Provider Second Line Business Practice Location Address:
B 6
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:
808-671-9433
Provider Business Practice Location Address Fax Number:
808-677-5455
Provider Enumeration Date:
09/22/2006