Provider First Line Business Practice Location Address:
94-216 FARRINGTON HWY
Provider Second Line Business Practice Location Address:
ST A102, BOX202
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-244-7632
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2016