Provider First Line Business Practice Location Address:
4504 KUKUI ST
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-823-0994
Provider Business Practice Location Address Fax Number:
808-823-0995
Provider Enumeration Date:
05/21/2007