Provider First Line Business Practice Location Address:
94-673 KUPUOHI ST
Provider Second Line Business Practice Location Address:
SUITE 201C
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-5367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-387-9477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006