Idaho
Division of Occupational and Professional Licenses
CARLA JENE SOUTHWICK
Board Of Medicine
License number
AT-565
Date granted
10/05/2015
Date expires
06/30/2017
Class
Board Of Medicine
Status
Renewed
Address
1432 SUMMER PL JEROME ID 83338
idaholicensing.com
ID 48353778
LAST UPDATED 2024-04-13 04:41:28 UTC
LAST UPDATED 2024-04-13 04:41:28 UTC
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