Provider First Line Business Practice Location Address:
91-1575 WAHANE ST
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:
96707-3106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-674-1926
Provider Business Practice Location Address Fax Number:
808-477-0005
Provider Enumeration Date:
04/26/2007