Provider First Line Business Practice Location Address:
94-1221 KA UKA BLVD.
Provider Second Line Business Practice Location Address:
SUITE B-205
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-397-3366
Provider Business Practice Location Address Fax Number:
833-288-5200
Provider Enumeration Date:
03/15/2018