Provider First Line Business Practice Location Address:
94-307 FARRINGTON HWY
Provider Second Line Business Practice Location Address:
SUITE A9
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:
808-782-8831
Provider Business Practice Location Address Fax Number:
808-671-1868
Provider Enumeration Date:
10/26/2006