Provider First Line Business Practice Location Address: 
221 MAHALANI ST
    Provider Second Line Business Practice Location Address: 
RADIOLOGY DEPARTMENT
    Provider Business Practice Location Address City Name: 
WAILUKU
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96793-2526
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-244-9056
    Provider Business Practice Location Address Fax Number: 
808-871-5587
    Provider Enumeration Date: 
08/04/2006