Provider First Line Business Practice Location Address:
1210 WARD AVE
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:
96814-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-538-1479
Provider Business Practice Location Address Fax Number:
808-537-5782
Provider Enumeration Date:
10/31/2013