Provider First Line Business Practice Location Address:
41-033 MANANA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIMANALO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96795-1615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-259-5505
Provider Business Practice Location Address Fax Number:
808-259-8598
Provider Enumeration Date:
09/11/2013