Provider First Line Business Practice Location Address:
94-1211 FARRINGTON HWY BLDG AA
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:
96797-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-835-6244
Provider Business Practice Location Address Fax Number:
808-678-9644
Provider Enumeration Date:
11/28/2018