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PRINTED: 06/07/2018 FORM APPROVED Hawaii Dept. of Health, Office of Health Care Assurance STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X3) DATE
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1 Kamani Street is a residential address located in a specific area.
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The resident or property owner of 1 Kamani Street may be required to file certain documents or reports related to the property.
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