Bill To:


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

Services Rendered To:


Michael Blankenship
689 Gallagher Road
McQueeney, Texas 78123
Policy # 013748870V71036


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

    Patient:

    Glenwood Warncke
    338 Spyglass
    McQueeney, TX 78123
    Policy # PA206933204

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 6000 Block of FM 725 - McQueeney, Texas

    Ordinance Info: RESOLUTION-McQueeney Cost Recovery Resolution 4521

Subtotal $500.00
Total Due $500.00


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