Provider First Line Business Practice Location Address:
96-212 WAIAWA RD APT 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-3382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-349-2255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2021