Provider First Line Business Practice Location Address:
94-941 KUHAULUA 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:
96797-2844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-304-3590
Provider Business Practice Location Address Fax Number:
808-379-0468
Provider Enumeration Date:
08/22/2021