Provider First Line Business Practice Location Address:
94 239 WAIPAHU DEPOT 87
Provider Second Line Business Practice Location Address:
SUITE #212
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-671-4958
Provider Business Practice Location Address Fax Number:
808-678-0191
Provider Enumeration Date:
02/05/2007