Bill To:


Elizabeth Deutsch
2958 Masters CT S.
Burleson, TX 76028

Services Rendered To:


Elizabeth Deutsch
2958 Masters CT S
Burleson, Texas 76028
Policy # 6055190102221


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

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

    Patient:

    Ethan Thrash

    2958 Masters CT S

    Burleson, Texas 76028

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 6132 FM 933 - Blum, Texas

Subtotal $1,500.00
Total Due $1,500.00


Updated
May 30, 2021 @ 1:11 pm

Invoice updated by Geoffrey.

Updated
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Invoice updated by Geoffrey.

Updated
June 27, 2022 @ 5:29 pm

Invoice updated by Geoffrey.

Updated
June 27, 2022 @ 5:36 pm

Invoice updated by Geoffrey.

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