Bill To:


Adam Gibson
600 Cobblestone Rd
Lafayette, LA 70508

Services Rendered To:


Adam Gibson
600 Cobblestone Rd
Lafayette, LA 70508


*** Please Submit this to your AUTO Insurance Company for processing and payment, OR YOU MAY CONTACT OUR OFFICE AND PROVIDE US WITH YOUR INSURANCE INFORMATION FOR PROCESSING. ***

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

    Patient

    John Nash
    367630 E 5440 Rd
    Terlton, OK 74081

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 5700 & Airport Rd- Terlton, OK

Subtotal $1,500.00
Total Due $1,500.00


Updated
July 14, 2023 @ 1:02 pm

Invoice updated by Geoffrey.