Provider First Line Business Practice Location Address:
98 1079 MOANALUA RD
Provider Second Line Business Practice Location Address:
#490
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:
808-486-8630
Provider Business Practice Location Address Fax Number:
808-488-9180
Provider Enumeration Date:
01/23/2007