Provider First Line Business Practice Location Address: 
400 ALA MAKANI ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
KAHULUI
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96732-3533
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-793-2005
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/26/2011