Provider First Line Business Practice Location Address:
599 FARRINGTON HWY STE 102
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:
96707-2028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-672-1142
Provider Business Practice Location Address Fax Number:
808-672-1143
Provider Enumeration Date:
08/28/2019