Provider First Line Business Practice Location Address:
55 LAKE BLVD
Provider Second Line Business Practice Location Address:
SHOPKO PHARMACY 096
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96003-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-241-0713
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2011