The holder whose full name is KING, JAY MAX,come from LOGANSPORT IN,hold the Physician license(NO.01015730A) which status is Expired Non-Renewable.
| Name | KING, JAY MAX |
|---|---|
| License Number | 01015730A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | LOGANSPORT |
| State | IN |