BRENT E. WALLACE
Idaho M-3811 Canceled
This Idaho license was held by BRENT E. WALLACE. The license is no longer active. It was granted on 07/17/1978 and expired on 07/01/1977
LICENSE DETAILS
- License Number: M-3811
- Category: Board Of Medicine
- Status: Canceled
- Date Granted: 07/17/1978 (about 48 years ago)
- Expiry Date: 07/01/1977 (about 49 years ago)
LOCATIONS
A Residential
3955 Harrison Boulevard Ogden UT 84403