Provider First Line Business Practice Location Address:
99-1191 IWAENA ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-3259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-486-7914
Provider Business Practice Location Address Fax Number:
808-486-7915
Provider Enumeration Date:
09/26/2006