Provider First Line Business Practice Location Address:
99-1379 KOAHA PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-3269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-487-4900
Provider Business Practice Location Address Fax Number:
808-486-1765
Provider Enumeration Date:
05/11/2006