Provider First Line Business Practice Location Address:
94-307 FARRINGTON HWY
Provider Second Line Business Practice Location Address:
SUITE B7B WALGREENS
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-2565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-676-2230
Provider Business Practice Location Address Fax Number:
808-678-2360
Provider Enumeration Date:
02/03/2011