Provider First Line Business Practice Location Address:
394 GLENNAN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHOFIELD BARRACKS
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-8199
Provider Business Practice Location Address Fax Number:
808-433-8334
Provider Enumeration Date:
02/22/2021