Provider First Line Business Practice Location Address: 
1401 S BERETANIA ST STE 730
    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: 
96814-1881
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-593-2830
    Provider Business Practice Location Address Fax Number: 
808-593-2940
    Provider Enumeration Date: 
07/07/2019