Provider First Line Business Practice Location Address:
91-2139 FORT WEAVER ROAD #310
Provider Second Line Business Practice Location Address:
ST. FRANCIS MEDICAL PLAZA - WEST
Provider Business Practice Location Address City Name:
EWA BEACH
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-676-9270
Provider Business Practice Location Address Fax Number:
808-676-9273
Provider Enumeration Date:
06/04/2007