Provider First Line Business Practice Location Address:
94-366 PUPUPANI ST
Provider Second Line Business Practice Location Address:
SUITE #209B
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-392-6361
Provider Business Practice Location Address Fax Number:
808-680-0015
Provider Enumeration Date:
03/26/2007