Provider First Line Business Practice Location Address:
99-124 KOHOMUA ST
Provider Second Line Business Practice Location Address:
15C
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-3876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-781-7984
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2015