Provider First Line Business Practice Location Address:
94-1085 AWANANI 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:
96797-3249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-452-2458
Provider Business Practice Location Address Fax Number:
808-207-0222
Provider Enumeration Date:
09/26/2026