Provider First Line Business Practice Location Address:
98-1238 KAAHUMANU ST
Provider Second Line Business Practice Location Address:
300
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-3250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-487-1235
Provider Business Practice Location Address Fax Number:
808-487-1236
Provider Enumeration Date:
09/20/2006