Provider First Line Business Practice Location Address:
1329 LUSITANA ST STE B5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-691-7050
Provider Business Practice Location Address Fax Number:
808-691-5399
Provider Enumeration Date:
10/25/2018