Provider First Line Business Practice Location Address:
94-595 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:
96797-5382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-688-0700
Provider Business Practice Location Address Fax Number:
808-688-1615
Provider Enumeration Date:
03/07/2024