Provider First Line Business Practice Location Address:
84 CENTRAL AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-870-1618
Provider Business Practice Location Address Fax Number:
808-878-8100
Provider Enumeration Date:
05/02/2007