Provider First Line Business Practice Location Address:
94-479 UKEE ST.
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-6602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-676-7661
Provider Business Practice Location Address Fax Number:
866-769-9693
Provider Enumeration Date:
10/23/2010