Provider First Line Business Practice Location Address:
1360 S BERETANIA ST
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-1520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-664-1104
Provider Business Practice Location Address Fax Number:
866-592-3149
Provider Enumeration Date:
01/23/2011