Provider First Line Business Practice Location Address: 
550 S BERETANIA ST STE 510
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HONOLULU
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96813-2496
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-691-2727
    Provider Business Practice Location Address Fax Number: 
808-691-4127
    Provider Enumeration Date: 
04/05/2017