Provider First Line Business Practice Location Address:
98-1079 MOANALUA RD STE 460
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:
96701-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-487-8922
Provider Business Practice Location Address Fax Number:
808-486-8466
Provider Enumeration Date:
12/08/2010