Bill To:


Sahara Williams
13811 Tahoe Vista
San Antonio, TX 78253

Services Rendered To:


Sahara Williams
13811 Tahoe Vista
San Antonio, TX 78253
POLICY# 001259539U 7108 3


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Product
Price
Qty
Amount
  1. 405 Medical Extrication – Lvl 1

    Patient

    Sahara Williams
    13811 Tahoe Vista
    San Antonio, TX 78253
    POLICY# 001259539U 7108 3

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US 59 N- Marshall, TX

Subtotal $500.00
Total Due $500.00


Updated
December 28, 2023 @ 12:50 pm

Invoice updated by Geoffrey.