Bill To:


Pam Smith
403 W Lamar St
Richland, TX 76681

Services Rendered To:


Clinton Owen
403 W Lamar St
Richland, TX 76681
POLICY# 29297


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Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient

    Pam Smith
    403 W Lamar St
    Richland, TX 76681

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-45 @ 219.5- Richland, TX

    Ordinance Info: Richland Billing Ordinance NO. 170 Cost Recovery

Subtotal $1,500.00
Total Due $1,500.00


Updated
December 16, 2022 @ 1:21 pm

Invoice updated by Geoffrey.

Updated
March 17, 2023 @ 4:28 pm

Invoice updated by Sherryf.