Provider First Line Business Practice Location Address:
91-1027 SHANGRILA ST BLDG 1867
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPOLEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96707-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-674-9595
Provider Business Practice Location Address Fax Number:
808-674-9696
Provider Enumeration Date:
06/19/2006