Provider First Line Business Practice Location Address:
94-1190 LUMIKULA 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:
96797-3943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-782-1381
Provider Business Practice Location Address Fax Number:
808-888-7808
Provider Enumeration Date:
08/07/2023