Provider First Line Business Practice Location Address:
98-1247 KAAHUMANU ST
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-678-1955
Provider Business Practice Location Address Fax Number:
808-678-1081
Provider Enumeration Date:
10/04/2006