Provider First Line Business Practice Location Address:
67-216 FARRINGTON HWY STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIALUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96791-9671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-637-4880
Provider Business Practice Location Address Fax Number:
808-637-4880
Provider Enumeration Date:
04/02/2010