Provider First Line Business Practice Location Address:
98-1268 KAAHUMANU ST
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-955-4775
Provider Business Practice Location Address Fax Number:
808-955-3130
Provider Enumeration Date:
12/15/2015