Provider First Line Business Practice Location Address:
94-374 APOWALE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-670-6424
Provider Business Practice Location Address Fax Number:
808-444-5445
Provider Enumeration Date:
11/21/2025