BRENT D. BLACK
Idaho M-4689 Canceled
This Idaho license was held by BRENT D. BLACK. The license is no longer active. It was granted on 09/01/1983
LICENSE DETAILS
- License Number: M-4689
- Category: Board Of Medicine
- Status: Canceled
- Date Granted: 09/01/1983 (over 41 years ago)
LOCATIONS
A Residential
534 South 425 West Tooele UT 84074