Provider First Line Business Practice Location Address:
3627 KILAUEA AVE RM101
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:
96816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-453-6593
Provider Business Practice Location Address Fax Number:
808-453-5940
Provider Enumeration Date:
04/30/2012