Provider First Line Business Practice Location Address:
830 KOLU ST
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-249-8680
Provider Business Practice Location Address Fax Number:
808-249-8650
Provider Enumeration Date:
05/19/2006