Provider First Line Business Practice Location Address:
1139 BETHEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-533-3892
Provider Business Practice Location Address Fax Number:
808-523-1240
Provider Enumeration Date:
02/28/2012