Provider First Line Business Practice Location Address: 
848 S BERETANIA ST STE 307
    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: 
96813-2551
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-532-8346
    Provider Business Practice Location Address Fax Number: 
808-532-2240
    Provider Enumeration Date: 
11/02/2006