Provider First Line Business Practice Location Address:
85-251 FARRINGTON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIANAE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96792-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-697-3520
Provider Business Practice Location Address Fax Number:
808-697-3521
Provider Enumeration Date:
10/30/2018