Provider First Line Business Practice Location Address:
94-221 PUPUKUI ST
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:
96797-2613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-383-9060
Provider Business Practice Location Address Fax Number:
808-376-0480
Provider Enumeration Date:
09/25/2026