Provider First Line Business Practice Location Address:
91-5480 KAPOLEI PKWY BLDG 5
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:
96707-5016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-650-6457
Provider Business Practice Location Address Fax Number:
808-622-7595
Provider Enumeration Date:
04/18/2025