Provider First Line Business Practice Location Address:
94-673 KUPUOHI ST STE C201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-5373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-983-1671
Provider Business Practice Location Address Fax Number:
808-983-1676
Provider Enumeration Date:
03/06/2014