Provider First Line Business Practice Location Address:
94-496 LOAA ST
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:
96797-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-744-6375
Provider Business Practice Location Address Fax Number:
808-744-6375
Provider Enumeration Date:
12/31/2009