Provider First Line Business Practice Location Address:
45-461 PUA INIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANEOHE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96744-2937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-235-5398
Provider Business Practice Location Address Fax Number:
808-235-6359
Provider Enumeration Date:
09/20/2006