Provider First Line Business Practice Location Address:
3465 WAIALAE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-753-7617
Provider Business Practice Location Address Fax Number:
808-735-3556
Provider Enumeration Date:
09/06/2006