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1003479320
MANNY BRICE KELLY
SAN BERNARDINO, CA
NPI
1003479320
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
167G00000X Licensed Psychiatric Technician
(Licence: CA 33817)
Enumeration Date
2019-04-22
Last Update Date
2019-04-22
Business Address
MANNY BRICE KELLY LPT
1481 WINDSOR DR
SAN BERNARDINO, CA 92404-5416
Phone number: 909-361-6472
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Mailing Address
MANNY BRICE KELLY LPT
2895 W FAIRVIEW DR
RIALTO, CA 92377-3425
Phone number: 909-435-5341
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