Provider First Line Business Practice Location Address: 
3800 KAMEHAMEHA RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
PRINCEVILLE
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96722-5326
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
510-333-4263
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/16/2022