Bill To:


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

Services Rendered To:


Crystal Stanfill
6206 Landmark Dr
Waco, TX 76710
POLICY# 0149624197101


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

    Patient

    Crystal Stanfill
    6206 Landmark Dr
    Waco, TX 76710
    POLICY# 0149624197101

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Fm 185 & Old School Pkwy- Waco, TX

Subtotal $1,500.00
Total Due $1,500.00


Updated
November 8, 2022 @ 2:29 pm

Invoice updated by Geoffrey.