Provider First Line Business Practice Location Address:
94-302 KAHUALENA 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:
96797-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-738-7412
Provider Business Practice Location Address Fax Number:
808-200-7547
Provider Enumeration Date:
05/03/2025