Provider First Line Business Practice Location Address:
1520 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-244-3661
Provider Business Practice Location Address Fax Number:
808-244-5470
Provider Enumeration Date:
05/23/2005