Idaho
Division of Occupational and Professional Licenses
JAIME E MANNING
Board Of Medicine
License number
PA-1390
Date granted
08/12/2016
Date expires
06/30/2018
Class
Board Of Medicine
Status
Licensed
Address
FAIRFAX ROAD AT VIRGINIA ST SALT LAKE CITY UT 84103
idaholicensing.com
ID 48360238
LAST UPDATED 2024-03-01 10:36:53 UTC
LAST UPDATED 2024-03-01 10:36:53 UTC
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