Provider First Line Business Practice Location Address:
QUEENS POB I
Provider Second Line Business Practice Location Address:
1380 LUSITANA ST 409
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-2440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-526-0033
Provider Business Practice Location Address Fax Number:
808-526-0034
Provider Enumeration Date:
12/12/2006