Provider First Line Business Practice Location Address:
94-1221 KA UKA BLVD
Provider Second Line Business Practice Location Address:
SUTE B206
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-6202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-664-1104
Provider Business Practice Location Address Fax Number:
866-592-3149
Provider Enumeration Date:
11/01/2012