Provider First Line Business Practice Location Address: 
642 ULUKAHIKI ST
    Provider Second Line Business Practice Location Address: 
#211
    Provider Business Practice Location Address City Name: 
KAILUA
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96734-4400
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-261-0765
    Provider Business Practice Location Address Fax Number: 
808-262-5636
    Provider Enumeration Date: 
05/12/2006