Provider First Line Business Practice Location Address:
BLDG. 3089 AVE. D
Provider Second Line Business Practice Location Address:
MARINE CORPS BASE HAWAII
Provider Business Practice Location Address City Name:
KANEOHE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-257-3365
Provider Business Practice Location Address Fax Number:
808-257-5653
Provider Enumeration Date:
09/25/2006