Provider First Line Business Practice Location Address:
94-103 PUPUOLE PL UNIT B
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:
96797-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-909-5161
Provider Business Practice Location Address Fax Number:
808-676-5675
Provider Enumeration Date:
10/14/2025