Provider First Line Business Practice Location Address:
4211 WAIALAE AVE
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816-5306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-732-6464
Provider Business Practice Location Address Fax Number:
808-732-6433
Provider Enumeration Date:
02/15/2007