Provider First Line Business Practice Location Address:
1380 LUSITANA STREET
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-550-8440
Provider Business Practice Location Address Fax Number:
808-550-8488
Provider Enumeration Date:
05/28/2006