Provider First Line Business Practice Location Address:
94-479 UKEE 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:
96797-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-265-5791
Provider Business Practice Location Address Fax Number:
808-791-4123
Provider Enumeration Date:
07/12/2007