Provider First Line Business Practice Location Address:
24 N CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-1680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-242-0077
Provider Business Practice Location Address Fax Number:
808-243-8007
Provider Enumeration Date:
03/08/2007