Provider First Line Business Practice Location Address:
92-1084 PALAHIA ST
Provider Second Line Business Practice Location Address:
APT K104
Provider Business Practice Location Address City Name:
KAPOLEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96707-3750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-389-9763
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2009