Provider First Line Business Practice Location Address:
4361 SALT LAKE BLVD
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:
96818-3124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-421-4240
Provider Business Practice Location Address Fax Number:
808-421-4240
Provider Enumeration Date:
06/27/2006