Provider First Line Business Practice Location Address:
1245 KUALA ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-784-2273
Provider Business Practice Location Address Fax Number:
808-784-2274
Provider Enumeration Date:
03/28/2013