Provider First Line Business Practice Location Address: 
86-260 FARRINGTON HWY
    Provider Second Line Business Practice Location Address: 
PREVENTIVE HEALTH DEPARTMENT
    Provider Business Practice Location Address City Name: 
WAIANAE
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96792-3128
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-697-3526
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/24/2011