Application For Additional Clinical Laboratory Testing Sites-Form B
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Application For Additional Clinical Laboratory Testing Sites-Form B Form. This is a California form and can be use in Department Of Health And Human Services Statewide.
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Tags: Application For Additional Clinical Laboratory Testing Sites-Form B, LAB 144 B, California Statewide, Department Of Health And Human Services
State of California--Health and Human Services Agency California Department of Public Health APPLICATION FOR ADDITIONAL CLINICAL LABORATORY TESTING SITES--FORM B List primary clinical laboratory and all additional clinical laboratory testing sites. Return Form B with form LAB 144 to: California Department of Public Health LABORATORY FIELD SERVICES 850 Marina Bay Parkway, Bldg. P, 1st Floor Richmond, CA 94804-6403 California ID number PRIMARY SITE Laboratory name CLIA number Laboratory location (number including room or suite number, street) Telephone number ( City State ) ZIP code ADDITIONAL SITE Laboratory name Telephone number ( Laboratory location (number including room or suite number, street) ) City State ZIP code ADDITIONAL SITE Laboratory name Telephone number ( Laboratory location (number including room or suite number, street) ) City State ZIP code ADDITIONAL SITE Laboratory name Telephone number ( Laboratory location (number including room or suite number, street) ) City State ZIP code ADDITIONAL SITE Laboratory name Telephone number ( Laboratory location (number including room or suite number, street) ) City State ZIP code ADDITIONAL SITE Laboratory name Telephone number ( Laboratory location (number including room or suite number, street) ) City State ZIP code THIS FORM MAY BE PHOTOCOPIED LAB 144 B (7/07) American LegalNet, Inc. www.FormsWorkflow.com
