Provider First Line Business Practice Location Address:
94-450 MOKUOLA ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-676-3948
Provider Business Practice Location Address Fax Number:
808-676-9507
Provider Enumeration Date:
10/06/2011