Ohio
Board of Licensing
Maynard, Lance-Grant Medical Center
Medical Board - 41.Pa Supervision Agreement
License number
41.18260-SA
Date granted
05/27/2014
Date expires
01/31/2017
Class
Medical Board - 41.Pa Supervision Agreement
Status
Active (In Renewal)
Address
323 E. Town St., Jackie Petty, Columbus, OH 43215
ohiolicensing.org
ID 29578274
LAST UPDATED 2026-04-06 23:18:10 UTC
LAST UPDATED 2026-04-06 23:18:10 UTC