Provider First Line Business Practice Location Address:
1259 S BERETANIA ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-591-1173
Provider Business Practice Location Address Fax Number:
808-591-1174
Provider Enumeration Date:
02/14/2012