Provider First Line Business Practice Location Address:
86-569 PAHEEHEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIANAE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96792-2827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-696-3021
Provider Business Practice Location Address Fax Number:
808-676-2810
Provider Enumeration Date:
02/24/2014