Provider First Line Business Practice Location Address:
46-005 KAWA ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
KANEOHE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96744-3805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-282-1081
Provider Business Practice Location Address Fax Number:
808-239-9493
Provider Enumeration Date:
05/19/2010