Provider First Line Business Practice Location Address:
94-1132 LUMIAUAU ST
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:
96797-3922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-636-1274
Provider Business Practice Location Address Fax Number:
808-082-6041
Provider Enumeration Date:
01/05/2021