Provider First Line Business Practice Location Address:
1109 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816-3714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-782-5061
Provider Business Practice Location Address Fax Number:
808-734-8904
Provider Enumeration Date:
12/20/2007