Provider First Line Business Practice Location Address:
94-210 PUPUKAHI ST STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-2649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-554-1163
Provider Business Practice Location Address Fax Number:
808-681-1486
Provider Enumeration Date:
07/29/2009