Provider First Line Business Practice Location Address:
94-1181 KA UKA BLVD STE C
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:
96797-4485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-260-9056
Provider Business Practice Location Address Fax Number:
808-444-3353
Provider Enumeration Date:
02/15/2016