Provider First Line Business Practice Location Address:
94-1144 KA UKA BLVD STE 10
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:
96797-4483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-218-3208
Provider Business Practice Location Address Fax Number:
808-443-0829
Provider Enumeration Date:
10/15/2026