Provider First Line Business Practice Location Address: 
3443 PAHOA AVE
    Provider Second Line Business Practice Location Address: 
HALE ALOHI
    Provider Business Practice Location Address City Name: 
HONOLULU
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96816-2158
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-737-2523
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/24/2014