Provider First Line Business Practice Location Address:
95 MAHALANI ST
Provider Second Line Business Practice Location Address:
19A
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-244-7467
Provider Business Practice Location Address Fax Number:
808-242-5835
Provider Enumeration Date:
09/16/2009