Provider First Line Business Practice Location Address:
92-366 WAIOMEA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPOLEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96707-1621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-682-2855
Provider Business Practice Location Address Fax Number:
808-682-2855
Provider Enumeration Date:
12/15/2006