Provider First Line Business Practice Location Address: 
1314 S KING ST
    Provider Second Line Business Practice Location Address: 
#1451
    Provider Business Practice Location Address City Name: 
HONOLULU
    Provider Business Practice Location Address State Name: 
HI
    Provider Business Practice Location Address Postal Code: 
96814-1956
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-521-8500
    Provider Business Practice Location Address Fax Number: 
808-521-8501
    Provider Enumeration Date: 
02/18/2016