Provider First Line Business Practice Location Address:
98 1247 KAAHUMANU STREET
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-5310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-488-4635
Provider Business Practice Location Address Fax Number:
808-488-3027
Provider Enumeration Date:
02/26/2007