Provider First Line Business Practice Location Address:
563 FARRINGTON HWY
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
KAPOLEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96707-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-693-8789
Provider Business Practice Location Address Fax Number:
808-693-8790
Provider Enumeration Date:
08/09/2005