Provider First Line Business Practice Location Address:
85-910 FARRINGTON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIANAE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-696-7031
Provider Business Practice Location Address Fax Number:
808-696-3010
Provider Enumeration Date:
06/27/2006