Provider First Line Business Practice Location Address:
86-213 KUWALE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIANAE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-696-9488
Provider Business Practice Location Address Fax Number:
808-537-4195
Provider Enumeration Date:
10/03/2006