Provider First Line Business Practice Location Address: 
56-660 KAMEHAMEHA HWY
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
KAHUKU
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96731-2210
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-293-7555
    Provider Business Practice Location Address Fax Number: 
808-293-7196
    Provider Enumeration Date: 
06/14/2010