Provider First Line Business Practice Location Address:
94-300 FARRINGTON HWY STE E02
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-677-2333
Provider Business Practice Location Address Fax Number:
808-677-2313
Provider Enumeration Date:
05/31/2006