Provider First Line Business Practice Location Address:
87-150 LUALEI PL
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:
96792-3652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-343-0311
Provider Business Practice Location Address Fax Number:
808-772-4016
Provider Enumeration Date:
02/23/2015