Provider First Line Business Practice Location Address:
98-1079 MOANALUA ROAD
Provider Second Line Business Practice Location Address:
SUITE 610
Provider Business Practice Location Address City Name:
ALEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-386-1716
Provider Business Practice Location Address Fax Number:
808-739-1979
Provider Enumeration Date:
11/02/2006