Provider First Line Business Practice Location Address:
94-615 KUPUOHI 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:
96797-5380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-832-8265
Provider Business Practice Location Address Fax Number:
808-832-8268
Provider Enumeration Date:
07/06/2018