Provider First Line Business Practice Location Address:
1259 SOUTH BERETANIA STREET
Provider Second Line Business Practice Location Address:
UNIT 4
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-591-1173
Provider Business Practice Location Address Fax Number:
808-591-1174
Provider Enumeration Date:
03/17/2007