Provider First Line Business Practice Location Address:
94-366 PUPUPANI STREET
Provider Second Line Business Practice Location Address:
SUITE 209B
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-597-6103
Provider Business Practice Location Address Fax Number:
808-680-0015
Provider Enumeration Date:
10/10/2013