Provider First Line Business Practice Location Address:
99-084 KAUHALE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-783-5359
Provider Business Practice Location Address Fax Number:
808-367-0629
Provider Enumeration Date:
03/14/2026