Provider First Line Business Practice Location Address:
94-1111 HOOMAKOA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-3723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-364-8806
Provider Business Practice Location Address Fax Number:
808-312-4733
Provider Enumeration Date:
11/01/2023