Provider First Line Business Practice Location Address:
94-110 KAUPU PL
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:
96797-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-784-9204
Provider Business Practice Location Address Fax Number:
808-888-7486
Provider Enumeration Date:
11/13/2015