Provider First Line Business Practice Location Address:
2100 HOOKIEKIE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-454-5664
Provider Business Practice Location Address Fax Number:
808-453-5619
Provider Enumeration Date:
01/27/2015