Provider First Line Business Practice Location Address:
98-1247 KAAHUMANU ST
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-487-5115
Provider Business Practice Location Address Fax Number:
808-488-8266
Provider Enumeration Date:
02/27/2007