Provider First Line Business Practice Location Address:
94-300 FARRINGTON HWY STE F05
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:
96797-2648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-677-1566
Provider Business Practice Location Address Fax Number:
808-671-6529
Provider Enumeration Date:
12/24/2009