Provider First Line Business Practice Location Address:
86-120 FARR HWY
Provider Second Line Business Practice Location Address:
A107
Provider Business Practice Location Address City Name:
WAIANAE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96792-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-772-2653
Provider Business Practice Location Address Fax Number:
808-696-5079
Provider Enumeration Date:
05/01/2012