Ohio
Board of Licensing
Beverley, Laurel-OPMG
Medical Board - 41.Pa Supervision Agreement
License number
41.8164-SA
Date granted
06/21/2007
Date expires
01/31/2015
Class
Medical Board - 41.Pa Supervision Agreement
Status
Active (In Renewal)
Address
12301 Snow Road, Parma, OH 44130
ohiolicensing.org
ID 28946274
LAST UPDATED 2026-04-25 16:23:01 UTC
LAST UPDATED 2026-04-25 16:23:01 UTC