Provider First Line Business Practice Location Address:
94-1257 KAHUAINA 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:
96797-3408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-348-1318
Provider Business Practice Location Address Fax Number:
808-490-0549
Provider Enumeration Date:
05/22/2025