Provider First Line Business Practice Location Address:
94-1097 LUMIAINA 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:
96797-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-729-3216
Provider Business Practice Location Address Fax Number:
808-200-5552
Provider Enumeration Date:
08/29/2016