Provider First Line Business Practice Location Address:
99-080 KAUHALE ST
Provider Second Line Business Practice Location Address:
D9
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:
808-483-4906
Provider Business Practice Location Address Fax Number:
808-483-4914
Provider Enumeration Date:
06/22/2007