Provider First Line Business Practice Location Address:
94-904 KUAKAHI ST
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:
96797-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-677-4969
Provider Business Practice Location Address Fax Number:
808-677-4969
Provider Enumeration Date:
11/20/2006