Provider First Line Business Practice Location Address:
94-478 KALUKALU 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:
96797-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-392-9126
Provider Business Practice Location Address Fax Number:
808-678-1821
Provider Enumeration Date:
08/19/2026