Provider First Line Business Practice Location Address:
94-050 FARRINGTON HWY
Provider Second Line Business Practice Location Address:
SUITE E1-1B
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-1841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-352-5094
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2008