Provider First Line Business Practice Location Address:
98-1038 MOANALUA RD
Provider Second Line Business Practice Location Address:
APT 1008
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-472-7086
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2007