| NPI | 1558803668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHALLON TORE CRADDOCK Owner 808-315-1519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: HI MD17956) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2016-11-07 |