Provider First Line Business Practice Location Address:
47-394 HUI IWA ST
Provider Second Line Business Practice Location Address:
APT 4
Provider Business Practice Location Address City Name:
KANEOHE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96744-4477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-421-8543
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2016