Provider First Line Business Practice Location Address:
1958 E VINEYARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-1715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-871-6996
Provider Business Practice Location Address Fax Number:
808-893-0866
Provider Enumeration Date:
01/09/2007