Provider First Line Business Practice Location Address:
2772 LANILOA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-1064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-425-0106
Provider Business Practice Location Address Fax Number:
808-461-2003
Provider Enumeration Date:
04/02/2026