Provider First Line Business Practice Location Address:
98-820 MOANALUA RD SPACE 5
Provider Second Line Business Practice Location Address:
PMB 161
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-845-6080
Provider Business Practice Location Address Fax Number:
808-845-6081
Provider Enumeration Date:
01/24/2020