Provider First Line Business Practice Location Address:
94-235 HANAWAI CIR
Provider Second Line Business Practice Location Address:
#1-B
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-3029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-671-0090
Provider Business Practice Location Address Fax Number:
80-671-5376
Provider Enumeration Date:
12/01/2005