Provider First Line Business Practice Location Address:
99-080 KAUHALE ST
Provider Second Line Business Practice Location Address:
SUITE C-22
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-487-1600
Provider Business Practice Location Address Fax Number:
808-487-1601
Provider Enumeration Date:
09/01/2009