Provider First Line Business Practice Location Address:
94-462 KIPOU 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:
96797-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-304-4877
Provider Business Practice Location Address Fax Number:
808-200-1452
Provider Enumeration Date:
09/16/2026