Provider First Line Business Practice Location Address:
94-1035 LEIHAKU 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:
96797-5257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-636-6568
Provider Business Practice Location Address Fax Number:
808-626-5968
Provider Enumeration Date:
02/16/2012