Provider First Line Business Practice Location Address:
98 1079 MOANALUA RD
Provider Second Line Business Practice Location Address:
STE 480
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-487-9667
Provider Business Practice Location Address Fax Number:
808-487-1484
Provider Enumeration Date:
08/18/2006