Provider First Line Business Practice Location Address:
89-188 FARRINGTON HWY
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:
96792-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-228-4164
Provider Business Practice Location Address Fax Number:
808-668-5434
Provider Enumeration Date:
02/07/2012