Provider First Line Business Practice Location Address: 
1001 KAMOKILA BLVD STE 210
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
KAPOLEI
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96707-2096
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-591-6060
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/01/2021