Provider First Line Business Practice Location Address:
94-1157 HALELEHUA 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:
96797-3705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-343-8423
Provider Business Practice Location Address Fax Number:
808-841-5573
Provider Enumeration Date:
03/09/2021