Provider First Line Business Practice Location Address:
2049 WELLS ST
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-244-8034
Provider Business Practice Location Address Fax Number:
808-244-8035
Provider Enumeration Date:
06/01/2006