Provider First Line Business Practice Location Address:
91-1010 SHANGRILLA STREET
Provider Second Line Business Practice Location Address:
KALAELOA PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
KAPOLEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-381-2267
Provider Business Practice Location Address Fax Number:
808-677-2570
Provider Enumeration Date:
11/26/2008