Provider First Line Business Practice Location Address:
1830 WELLS ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-242-5599
Provider Business Practice Location Address Fax Number:
808-242-2838
Provider Enumeration Date:
05/29/2006