Bill To:


STATE FARM INSURANCE
PO BOX 52250
PHOENIX, AZ 85072-2250

Services Rendered To:


John Soble
226 Oak Ridge
Murchison, TX 75778
POLICY # 332 8717 H02 43C 002


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

    Patient:

    John Soble
    226 Oak Ridge
    Murchison, TX 75778
    POLICY # 332 8717 H02 43C 002

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA w/Entrapment Response

    Incident Location: FM 279 East of County Road 4822 - Ben Wheeler, Texas

Subtotal $1,500.00
Total Due $1,500.00


Updated
June 1, 2022 @ 6:46 pm

Invoice updated by Geoffrey.

Viewed
December 28, 2022 @ 7:44 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.

Viewed
December 28, 2022 @ 7:48 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.