Provider First Line Business Practice Location Address:
OFFICE OF STUDENT SUPPORT MEDICAID REIMBURSEMENT
Provider Second Line Business Practice Location Address:
475 22ND AVE, BLDG 302, ROOM 101
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-305-9750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2019