Bill To:


United Health Care
PO Box 740800
Atlanta, GA 30374-0800

Services Rendered To:


Dora Waguespack
3765 S. Dobbs Road
Newalla, OK 73045
Policy # 916524584-00


Product
Price
Qty
Amount
  1. 410 Fire Department Response Fee – Lvl 1

    $200.00
    1
    $200.00

  2. Additional Incident Info

    Incident Type: Fire Department Response

    Incident Location: 3765 S. Dobbs Road Newalla, OK 73045

Subtotal $200.00
Total Due $200.00


Updated
April 22, 2022 @ 7:25 pm

Invoice updated by Geoffrey.

Status Update
April 22, 2022 @ 7:25 pm

Status changed: Draft to Pending.

Updated
April 22, 2022 @ 7:26 pm

Invoice updated by Geoffrey.