Provider First Line Business Practice Location Address:
94-428 MOKUOLA ST
Provider Second Line Business Practice Location Address:
SUITE 108-B
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-3396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-696-7081
Provider Business Practice Location Address Fax Number:
808-696-7093
Provider Enumeration Date:
11/20/2006