Provider First Line Business Practice Location Address:
94-873 FARRINGTON HWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-3150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-671-3937
Provider Business Practice Location Address Fax Number:
808-671-3936
Provider Enumeration Date:
06/06/2007