Provider First Line Business Practice Location Address:
90-1011 LEXINGTON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPOLEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
76707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-550-0005
Provider Business Practice Location Address Fax Number:
808-550-0009
Provider Enumeration Date:
01/09/2009