Provider First Line Business Practice Location Address: 
777 HANA HWY
    Provider Second Line Business Practice Location Address: 
#206
    Provider Business Practice Location Address City Name: 
PAIA
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96779-8124
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-268-3527
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/21/2011