Bill To:


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

Services Rendered To:


Gary Edwards
375 County Rd 132
Jemison, AL 35085
POLICY# 0135727460


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

    Patient

    Gary Edwards
    375 County Rd 132
    Jemison, AL 35085
    POLICY# 0135727460

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 12550 CR 42- Jemison, AL

Subtotal $1,500.00
Total Due $1,500.00


Updated
October 17, 2023 @ 2:57 pm

Invoice updated by Geoffrey.

Viewed
March 20, 2024 @ 5:44 pm

Invoice viewed by 66.249.72.4 for the first time.