Provider First Line Business Practice Location Address:
94-828 LUMIAUAU ST
Provider Second Line Business Practice Location Address:
M204
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-354-2187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2014