Provider First Line Business Practice Location Address:
99-185 MOANALUA RD
Provider Second Line Business Practice Location Address:
#106
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-488-6330
Provider Business Practice Location Address Fax Number:
808-486-7501
Provider Enumeration Date:
04/25/2007