Provider First Line Business Practice Location Address:
94-1055 KUHAULUA 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:
96797-2851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-692-3140
Provider Business Practice Location Address Fax Number:
808-888-7605
Provider Enumeration Date:
06/25/2010