Provider First Line Business Practice Location Address:
98-1079 MOANALUA ROAD
Provider Second Line Business Practice Location Address:
MEDICAL OFFICE BUILDING, SUITE 300
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-485-4120
Provider Business Practice Location Address Fax Number:
808-485-3090
Provider Enumeration Date:
03/27/2013