Provider First Line Business Practice Location Address:
98-1005 MOANALUA RD
Provider Second Line Business Practice Location Address:
SPC 400
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-488-0958
Provider Business Practice Location Address Fax Number:
808-484-0857
Provider Enumeration Date:
07/02/2007