Provider First Line Business Practice Location Address:
220 IMI KALA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-244-6879
Provider Business Practice Location Address Fax Number:
808-873-0273
Provider Enumeration Date:
05/28/2015