Provider First Line Business Practice Location Address:
651 ILALO ST
Provider Second Line Business Practice Location Address:
MEB 307-H
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-5525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-692-1047
Provider Business Practice Location Address Fax Number:
808-692-1255
Provider Enumeration Date:
04/20/2007