Provider First Line Business Practice Location Address:
99-902 MOANALVA ROAD
Provider Second Line Business Practice Location Address:
HALAWA CORRECTIONAL FACILITY
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-484-5426
Provider Business Practice Location Address Fax Number:
808-484-6955
Provider Enumeration Date:
09/28/2006