Provider First Line Business Practice Location Address:
95-550 LANIKUHANA AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILILANI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-623-0702
Provider Business Practice Location Address Fax Number:
808-623-9677
Provider Enumeration Date:
02/25/2009