Provider First Line Business Practice Location Address:
94-553 LAENUI 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:
96797-3863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-469-8264
Provider Business Practice Location Address Fax Number:
808-676-7919
Provider Enumeration Date:
02/08/2022