MARK STEPHEN RUSSUM
Idaho LRT-360 Canceled
This Idaho license was held by MARK STEPHEN RUSSUM. The license is no longer active. It was granted on 09/04/1992 and expired on 07/02/2002
LICENSE DETAILS
- License Number: LRT-360
- Category: Board Of Medicine
- Status: Canceled
- Date Granted: 09/04/1992 (over 31 years ago)
- Expiry Date: 07/02/2002 (almost 22 years ago)
LOCATIONS
A Residential
PO Box 668 Kooskia ID 83539