ALLAN RANDOLPH SUPAK
Idaho TLM-2785 Upgraded
This Idaho license was held by ALLAN RANDOLPH SUPAK. The license is no longer active. It was granted on 10/21/1998
LICENSE DETAILS
- License Number: TLM-2785
- Category: Board Of Medicine
- Status: Upgraded
- Date Granted: 10/21/1998 (over 26 years ago)
LOCATIONS
A Residential
PO Box 2083 Salmon ID 83467