Provider First Line Business Practice Location Address:
92-920 PALAILAI ST APT 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPOLEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96707-1281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-204-5168
Provider Business Practice Location Address Fax Number:
808-444-7044
Provider Enumeration Date:
04/03/2023