Provider First Line Business Practice Location Address:
91-1241 SARATOGA AVENUE
Provider Second Line Business Practice Location Address:
BLDG 1924
Provider Business Practice Location Address City Name:
KAPOLEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-481-7391
Provider Business Practice Location Address Fax Number:
808-488-6952
Provider Enumeration Date:
02/05/2007