Provider First Line Business Practice Location Address:
99-1253 HALAWA VALLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-3281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-486-2933
Provider Business Practice Location Address Fax Number:
808-486-6458
Provider Enumeration Date:
05/23/2007