Provider First Line Business Practice Location Address:
85-979 MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIANAE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96792-2645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-696-9498
Provider Business Practice Location Address Fax Number:
808-696-9403
Provider Enumeration Date:
06/03/2008