Provider First Line Business Practice Location Address:
99-115 AIEA HEIGHTS DR STE 219
Provider Second Line Business Practice Location Address:
SUITE 219
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-3974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-485-1070
Provider Business Practice Location Address Fax Number:
808-488-9301
Provider Enumeration Date:
10/30/2009