Provider First Line Business Practice Location Address:
94-229 WAIPAHU DEPOT ST
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-676-1192
Provider Business Practice Location Address Fax Number:
808-676-1193
Provider Enumeration Date:
06/08/2006