Provider First Line Business Practice Location Address:
94-132 POOHUKU WAY
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:
96797-5808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-393-9032
Provider Business Practice Location Address Fax Number:
808-200-4118
Provider Enumeration Date:
10/05/2023