Provider First Line Business Practice Location Address:
94-210 PUPUKAHI ST
Provider Second Line Business Practice Location Address:
SUITE # 102
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-2649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-330-3025
Provider Business Practice Location Address Fax Number:
808-838-7414
Provider Enumeration Date:
04/05/2008