Provider First Line Business Practice Location Address:
220 IMI KALA ST STE 203A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-283-8640
Provider Business Practice Location Address Fax Number:
808-633-8425
Provider Enumeration Date:
07/10/2025