Provider First Line Business Practice Location Address:
91-614 POHAKUPUNA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EWA BEACH
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96706-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-753-5990
Provider Business Practice Location Address Fax Number:
808-784-0698
Provider Enumeration Date:
10/14/2016