Provider First Line Business Practice Location Address:
15TH MEDICAL GROUP SGSBR
Provider Second Line Business Practice Location Address:
755 SCOTT CIRCLE
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96853-5399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-449-2295
Provider Business Practice Location Address Fax Number:
808-449-2297
Provider Enumeration Date:
02/13/2006