Bill To:


USAA INSURANCE – MEDICAL CLAIMS
PO BOX 5000
DAPHNE, AL 36526-5000

Services Rendered To:


Isabella Grace Griffis
317 Norwood Court
Schertz, Texas 78108
Policy # 014553130U-71067


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

    Patient:

    Isabella Grace Griffis
    317 Norwood Court
    Schertz, Texas 78108
    Policy # 014553130U-71067

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 78 & FM 1620 - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $500.00
Total Due $500.00


Updated
October 7, 2021 @ 3:06 pm

Invoice updated by Geoffrey.

Viewed
March 29, 2024 @ 7:45 pm

Invoice viewed by 66.249.72.5 for the first time.