Provider First Line Business Practice Location Address:
94-615 KUPUOHI 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:
96797-1124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-677-5999
Provider Business Practice Location Address Fax Number:
808-678-6556
Provider Enumeration Date:
07/18/2007