Provider First Line Business Practice Location Address:
3221 WAIALAE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816-5842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-735-2811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2026