Provider First Line Business Practice Location Address: 
480 CENTRAL AVE
    Provider Second Line Business Practice Location Address: 
NHCH ATTN: KRISTI HAIPO- CREDENTIALS
    Provider Business Practice Location Address City Name: 
JBPHH
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96860-4908
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-473-1880
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/27/2014