Provider First Line Business Practice Location Address:
1345 S BERETANIA ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-798-2788
Provider Business Practice Location Address Fax Number:
808-748-0000
Provider Enumeration Date:
02/02/2016