Bill To:


Louis Duke
153 Lindsey Hill Road
Dover, AR 72837

Services Rendered To:


Louis Duke
330 PVT Road 721
Broaddus, Texas 75929
Policy # 331 7878-E03-43J-001


*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

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

    Patient:

    Louis Duke
    330 PVT Road 721
    Broaddus, Texas 75929
    Policy # 331 7878-E03-43J-001

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 22000 Block of Highway 69 South - Zavalla, Texas

Subtotal $500.00
Total Due $500.00


Updated
March 19, 2021 @ 12:21 pm

Invoice updated by Geoffrey.

Updated
December 13, 2021 @ 4:12 pm

Invoice updated by Geoffrey.