Provider First Line Business Practice Location Address:
91-600 FARRINGTON HWY UNIT 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPOLEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96707-4509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-674-4488
Provider Business Practice Location Address Fax Number:
808-674-2409
Provider Enumeration Date:
09/17/2012