Provider First Line Business Practice Location Address: 
1575 S BERETANIA ST
    Provider Second Line Business Practice Location Address: 
#201-202
    Provider Business Practice Location Address City Name: 
HONOLULU
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96826-1149
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-946-1712
    Provider Business Practice Location Address Fax Number: 
808-946-1728
    Provider Enumeration Date: 
08/13/2006