Provider First Line Business Practice Location Address: 
1907 SOUTH BERETANIA ST
    Provider Second Line Business Practice Location Address: 
ARTESIAN PLAZA FIRST FLOOR KAPIOLANI WOMENS CENTER
    Provider Business Practice Location Address City Name: 
HONOLULU
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96826
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-973-6540
    Provider Business Practice Location Address Fax Number: 
808-973-6537
    Provider Enumeration Date: 
04/11/2007