Provider First Line Business Practice Location Address:
91-2139 FORT WEAVER RD
Provider Second Line Business Practice Location Address:
2228 LILIHA STREET
Provider Business Practice Location Address City Name:
EWA BEACH
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96706-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-680-0558
Provider Business Practice Location Address Fax Number:
808-680-0500
Provider Enumeration Date:
02/03/2007