Provider First Line Business Practice Location Address: 
1288 KAPIOLANI BLVD APT 1508
    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: 
96814-2868
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-382-8199
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/20/2013