Provider First Line Business Practice Location Address:
590 MOFFET ST, BLDG 4077
Provider Second Line Business Practice Location Address:
JOINT BASE PEARL HARBOR-HICKAM
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96853-5168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-448-4500
Provider Business Practice Location Address Fax Number:
808-448-4589
Provider Enumeration Date:
12/13/2005