Provider First Line Business Practice Location Address:
1149 BETHEL ST
Provider Second Line Business Practice Location Address:
RM 205
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-2236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-538-7504
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2007