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Individual

MRS. SALLY J MOORE

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2490 OKA ST, KILAUEA, HI 96754-5332
(808) 828-1418
(808) 828-1666
Mailing address
3667 ANINI RD, KILAUEA, HI 96754-5212
(808) 828-1150
(808) 828-9714

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
16
HI

Other

Enumeration date
06/14/2006
Last updated
07/08/2007
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