Provider First Line Business Practice Location Address:
94-1144 KA UKA BLVD
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:
96797-4483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-531-2244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2017