Idaho
Division of Occupational and Professional Licenses
DAVID WANLESS SOUTHWICK
Board Of Medicine
License number
LRT-1108
Date granted
06/24/2005
Date expires
06/30/2018
Class
Board Of Medicine
Status
Renewed
Address
463 SOUTH SILVER BOW AVE EAGLE ID 83616
idaholicensing.com
ID 48353779
LAST UPDATED 2024-01-30 14:41:05 UTC
LAST UPDATED 2024-01-30 14:41:05 UTC
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