Provider First Line Business Practice Location Address:
1522 AHONUI ST APT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96819-5519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-728-9131
Provider Business Practice Location Address Fax Number:
808-841-1099
Provider Enumeration Date:
07/19/2011