Provider First Line Business Practice Location Address:
1380 LUSITANA ST
Provider Second Line Business Practice Location Address:
209
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-2449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-524-1432
Provider Business Practice Location Address Fax Number:
808-524-1338
Provider Enumeration Date:
01/21/2011