Provider First Line Business Practice Location Address:
94-1144 KA UKA BLVD #5
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-201-3636
Provider Business Practice Location Address Fax Number:
808-427-5151
Provider Enumeration Date:
07/31/2017