Provider First Line Business Practice Location Address:
98-211 PALI MOMI ST
Provider Second Line Business Practice Location Address:
STE 803
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-487-7997
Provider Business Practice Location Address Fax Number:
808-487-7166
Provider Enumeration Date:
08/26/2005