Provider First Line Business Practice Location Address:
95 MAHALANI ST
Provider Second Line Business Practice Location Address:
SUITE 21
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-442-6856
Provider Business Practice Location Address Fax Number:
808-249-0107
Provider Enumeration Date:
10/19/2011