Provider First Line Business Practice Location Address:
94-233 KAHUANANI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-853-0901
Provider Business Practice Location Address Fax Number:
808-676-5866
Provider Enumeration Date:
09/14/2026