Provider First Line Business Practice Location Address:
560 N NIMITZ HWY
Provider Second Line Business Practice Location Address:
SUITE 114B
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817-5330
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:
04/29/2014