Provider First Line Business Practice Location Address:
1414 WARD AVE
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96822-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-612-8364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2012