Provider First Line Business Practice Location Address:
94-1161 HEAHEA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-773-2520
Provider Business Practice Location Address Fax Number:
808-200-4013
Provider Enumeration Date:
09/29/2017