Provider First Line Business Practice Location Address:
94-239 WAIPAHU DEPOT ST
Provider Second Line Business Practice Location Address:
106
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-3056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-677-1912
Provider Business Practice Location Address Fax Number:
866-610-1585
Provider Enumeration Date:
12/27/2005