Provider First Line Business Practice Location Address: 
1038 KUEKUE ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HONOLULU
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96825-4141
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
714-606-9082
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/25/2022