Provider First Line Business Practice Location Address:
54 S HIGH ST
Provider Second Line Business Practice Location Address:
ROOM 301
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-984-2136
Provider Business Practice Location Address Fax Number:
808-984-8222
Provider Enumeration Date:
03/21/2011