Provider First Line Business Practice Location Address:
96-239 WAIAWA RD # HOUSEB
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-748-9413
Provider Business Practice Location Address Fax Number:
808-671-7108
Provider Enumeration Date:
01/14/2019